Dysmenorrhea is a prevalent gynecological condition characterized by painful uterine contractions that lead to recurrent pelvic pain, particularly among adolescents and young adult women. It is generally categorized into two subtypes: primary dysmenorrhea, which occurs without identifiable pelvic pathology and typically responds well to analgesic therapy, and secondary dysmenorrhea, which is often more severe and associated with underlying conditions such as endometriosis or uterine fibroids [1, 2, 3].

Globally, dysmenorrhea affects between 50% and 90% of menstruating women [4, 5, 6, 7, 8]. In Saudi Arabia, the burden appears to be particularly high, with a reported prevalence ranging from 70% to 92.3% [9, 10, 11, 12, 13, 14, 15]. This condition has been found to significantly disrupt daily activities, academic performance, and overall quality of life [16]. While numerous international and national studies have examined its prevalence, variations in study design and data collection tools, particularly the inconsistent use of systems for grading severity, have contributed to heterogeneity in the reported outcomes. In many cases, emphasis has been placed on estimating the prevalence of dysmenorrhea, with less attention given to the standardized assessment of symptom intensity and functional effects, thus making it difficult to examine potential associations with clinical and demographic factors [11, 15].

To address these limitations, the Work ability, Location, Intensity, Duration of Dysmenorrhea (WaLIDD) score developed by Teherán et al. (2018) [17] provides a validated and multidimensional approach for grading the severity of dysmenorrhea in the range from none to severe. This tool allows for more objective assessments and consistent comparisons across populations, while including factors such as body mass index (BMI) and menstrual characteristics in the analysis. Previous studies have suggested an association between higher BMI and increased severity of dysmenorrhea, as well as a strong relation between symptom severity and reduced quality of life [18, 19, 20, 21].

Only a limited number of studies conducted in Saudi Arabia have used the WaLIDD score to assess dysmenorrhea. Notably, Alateeq et al. (2022) [12] examined its association with depression, while Almanasef and Alqarni (2023) [15] investigated self-management strategies. While both studies provide valuable contributions, neither focused on the relationship between the severity of dysmenorrhea and clinical or menstrual characteristics. The goal of the present study was to fill that gap by assessing the prevalence, severity, and functional effects of dysmenorrhea among female university students in Hafr Al Batin, Eastern Saudi Arabia, using the WaLIDD score. We also investigated associations between the severity of dysmenorrhea and key variables such as age, BMI, and menstrual characteristics. By using a standardized and validated tool, this research has the potential to enhance clinical understanding, support targeted interventions, and promote greater awareness of menstrual health among young women.

This study offers important insights into the prevalence, severity, and functional effects of dysmenorrhea on female university students in Hafr Al Batin. It represents the first investigation of dysmenorrhea in this particular region of Saudi Arabia. Our findings are consistent with global trends, which underscore the high prevalence of dysmenorrhea and its significant impacts on women’s health and well-being. Dysmenorrhea, particularly primary dysmenorrhea, is a common condition that affects a substantial proportion of women worldwide, with estimates ranging from 50% to over 90% [7, 22]. The prevalence in Saudi Arabia is similarly high, as demonstrated by Bakhsh et al. (2022) [10] who conducted the largest study to date on 1199 women of reproductive age and reported a dysmenorrhea prevalence of 92.3%.

In our cohort, 39.5% of participants reported experiencing severe dysmenorrhea, which is comparable to the findings of several international studies [7, 22]. This high prevalence underscores the significant burden of dysmenorrhea on young women in this region, and is consistent with other studies that have reported high rates of menstrual pain, particularly among university students [23, 24]. It is notable that the severity of dysmenorrhea in the present study was significantly associated with a higher BMI, a history of gynecological disease, and a greater likelihood of seeking medical consultation. Our results are consistent with those of previous studies that have linked these factors to more severe menstrual pain [20, 25]. The observed odds ratio of 1.11 indicates that each unit increase in BMI is associated with an approximately 11% higher likelihood of experiencing more severe dysmenorrhea. Although modest on an individual level, this effect becomes clinically meaningful at the population level, especially in regions where overweight and obesity are prevalent. These findings suggest that weight management interventions, including lifestyle modifications such as diet and physical activity, could play a role in alleviating the severity of dysmenorrhea. Incorporating BMI assessment into routine gynecological care may therefore provide an opportunity for early counseling and targeted interventions to improve menstrual health outcomes.

The prevalence of dysmenorrhea observed in Saudi Arabia is notably higher than that reported in many other countries. The results from Saudi studies are consistently higher, with the reported incidence ranging from about 70% to 90% [10, 13]. In contrast, a much lower prevalence of dysmenorrhea has been reported in some countries. For example, studies from China and Iran have reported rates as low as 41% [26, 27], whereas in parts of Europe they approach 90% [28, 29]. Several factors might account for the elevated rates and burdens seen in Saudi women. One important consideration is population demographics. Many of the participants were young and nulliparous, an age group known to have more frequent and severe dysmenorrhea, which typically diminishes with older age and childbirth [30]. Cultural and healthcare-related factors could further exacerbate the problem. Limited awareness or stigma surrounding menstruation and the lack of sex education might prevent Saudi women from seeking effective management, thereby increasing the reported intensity and impact of symptoms. Up to 87% of Saudi women consistently report menstruation-related interference in daily activities, which is far above the ~38% of women globally who experience such a severe impact [9]. These considerations suggest that sociocultural factors contribute to the comparatively high prevalence of dysmenorrhea and the associated burden observed in Saudi Arabia. To mitigate this, universities could integrate menstrual health workshops into orientation programs, while policymakers should consider pilot revisions of school curricula to improve early health literacy. Additionally, variations in how dysmenorrhea is defined and measured, including the lack of standardized diagnostic criteria and differences in study populations, complicate cross-study comparisons and likely contribute to the wide range in reported prevalence.

Menstrual characteristics, including irregular cycles and heavier menstrual flow, were also strongly associated with the severity of dysmenorrhea in this study. Participants with severe dysmenorrhea were significantly more likely to report irregular cycles and heavy menstrual flow, which are established risk factors for stronger pain intensity [5, 31]. Moreover, our results revealed that menstrual pain significantly interfered with daily activities, including academic attendance. This is consistent with previous studies that reported adverse effects of dysmenorrhea on education and work performance [23, 32].

The significant relation between dysmenorrhea and diminished quality of life noted in our study is a major concern. Severe dysmenorrhea was found to affect the ability of participants to engage in daily tasks. Some degree of impairment was reported by 97.4% of women with severe symptoms. This finding is consistent with those of Amza et al. [22], who found that dysmenorrhea significantly reduces the health-related quality of life, particularly in physical and emotional functioning domains. Furthermore, 75.9% of women with severe dysmenorrhea reported missing 1 to 3 lectures because of pain, consistent with earlier studies reporting academic disruption due to menstrual pain [24, 33].

Several factors that influence the onset and severity of dysmenorrhea have been identified, including age at menarche, family history, lifestyle factors, and psychosomatic aspects. Our study corroborates the importance of a family history of dysmenorrhea, as participants in the severe group were more likely to report a familial predisposition [26, 34]. Psychosomatic factors, such as stress and pain tolerance, have also been linked to the severity of dysmenorrhea in other populations [35, 36].

Our study was conducted over an 18-month period from May 2023 to November 2024, spanning all four seasons. Seasonal variation in factors such as temperature, vitamin D exposure, mood, and physical activity may influence the severity of dysmenorrhea. For example, colder months may be associated with increased muscle tension or reduced physical activity, potentially exacerbating pain symptoms [37]. Because the timing of our data collection did not control for seasonality, this could represent a source of variability in symptom reporting. Future studies may benefit from examining seasonal trends more explicitly, or stratifying data collection accordingly to assess potential seasonal effects.

This study has several limitations that should be considered. The sample was drawn from a single academic institution, which limits the ability to generalize the findings to other regions or populations. In addition, the cross-sectional study design does not allow causal inferences to be drawn. Future research should include more diverse samples and employ longitudinal methodologies to build on these results and provide a better understanding of dysmenorrhea and its associated factors. The use of self-reported data may also have led to recall bias and social desirability bias. While self-reporting remains a practical and widely accepted method for assessing menstrual symptoms, responses may still be influenced by personal interpretation or hesitancy in disclosure. Finally, due to logistical constraints, convenience sampling was used for efficient recruitment within a defined academic setting. While this method facilitates access to a relevant population, it introduces potential selection bias and limits the generalizability of findings to broader populations. Participants who chose to respond may differ systematically from non-respondents in ways that affect their reporting of dysmenorrhea prevalence or severity.

Despite these limitations, our study has solid clinical applications. Healthcare providers in Saudi Arabia can use the findings of recent dysmenorrhea research to make practical, evidence-based improvements in care. One key step is to incorporate the WaLIDD score into routine practice. Providers should proactively and routinely screen women of reproductive age, particularly those with high risk factors such as elevated BMI, prior to the development of symptoms. WaLIDD scores can help in the early identification of women with significant pain and in whom intervention is warranted. Such screening is crucial in the Saudi context, where many women normalize menstrual pain and avoid seeking care. A high WaLIDD score in an at-risk patient should prompt personalized counseling on lifestyle modifications (weight management, exercise) to help reduce symptoms, as well as timely referrals. It can also be used to guide treatment adjustments for better pain management, such as optimizing the use of nonsteroidal anti-inflammatory drug (NSAID) or trialing hormonal therapies.

This study provides important insights into the prevalence and impact of dysmenorrhea among female university students in the Eastern region of Saudi Arabia. The findings indicate that severe dysmenorrhea is both common and significantly disruptive, affecting daily activities, academic attendance, and overall quality of life. Factors such as elevated BMI, irregular menstrual cycles, and heavier menstrual flow were significantly associated with an increased severity of dysmenorrhea, consistent with the findings of similar global studies.

These results underscore the need for improved management strategies and targeted interventions to support young women in managing their symptoms. Given the complex nature of dysmenorrhea, which includes both physical and psychological components, a multidisciplinary approach to treatment may be particularly beneficial.

Future research should aim to include more diverse populations and longitudinal study designs to better understand the long-term effects of dysmenorrhea and develop effective prevention strategies. This study helps fill a critical gap in the regional literature and emphasizes the need for greater awareness and support for women experiencing this condition.

The data that support the findings of this study are available from the corresponding author, Zahraa Alali, upon reasonable request.

ZA contributed to the conceptualization of the study, sample collection, data analysis, and writing of the manuscript. ZA has read and approved the final version of the manuscript and agrees to be accountable for all aspects of the work.

The study was carried out in accordance with the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board (IRB) at the University of Hafr Al Batin (Approval No.: UHB-003-03-2023). All participants provided written informed consent prior to enrollment, ensuring voluntary participation and confidentiality in accordance with the ethical guidelines for research involving human subjects.

This research was supported by the Deanship of Scientific Research at the University of Hafr Al Batin, under project number [0068-1443-S].

The author declares no conflict of interest.

AI-based tools, including ChatGPT and QuillBot, were used to enhance the grammar and clarity of the manuscript. All scientific content, data analysis, and conclusions are entirely the work of the author, who assumes full responsibility for the integrity and accuracy of the publication.