Ovarian cancer is one of the leading causes of cancer-related deaths in women. A recent study published in the International Journal of Cancer evaluated whether severe menstrual pain is associated with an increased risk of ovarian cancer.
Ovarian cancer is the fifth most common cause of female cancer-related deaths in the United States with more than 85% being diagnosed at a late stage of the disease when cancer has spread outside of the ovary. Understanding the role of certain risk factors for the development of ovarian cancer can lead to early screening of women with a higher chance of the disease. Menstrual pain, also known as dysmenorrhea, is associated with increased inflammation and, like many other inflammatory conditions including endometriosis and pelvic inflammatory disease, has been studied in relation to the risk of developing ovarian cancer.
What is the Link Between Menstrual Pain and Cancer?
To examine the association between severe menstrual pain and ovarian cancer risk, Babic and colleagues interpreted data from the Ovarian Cancer Association Consortium (OCAC), an international collaboration of factors affecting ovarian cancer risk. This study, recently published in the International Journal of Cancer, included the statistics of 10,592 women with ovarian cancer and 13,320 who did not have the disease.
They examined nine study sites and participants were given a questionnaire that included either direct or indirect questions regarding their experience of menstrual pain. Direct questions were those that asked patients whether they had experienced severe or significant menstrual pain. Indirect questions inquired about using various over the counter medications such as oral contraceptives, hormones, and NSAIDs, or intrauterine devices to cope with menstrual pain. Menstrual pain that required any of the previously mentioned interventions was considered as severe.
Severe Menstrual Pain was Associated with Cancer Risk
Compared to women without ovarian cancer, women who had a diagnosis of ovarian cancer we more likely to not have had any children have used oral contraceptives for a shorter period of time, had a family history of breast or ovarian cancer more frequently and experienced severe menstrual pain more often. The sites that were asked indirect questions (5.3%) regarding severe menstrual pain reported it less often than the sites that were asked direct questions (30.3%). There was association found between ovarian cancer risk and severe menstrual pain in the studies that used indirect questions.
Women who reported frequent severe pain were at 17% increased risk of developing ovarian cancer compared to women without severe pain. Women who reported severe pain for longer than 12 years had an 18% increase in the risk of ovarian cancer when compared to women with no severe pain.
Of the various types of ovarian cancers, the risk associated with severe menstrual pain was most evident for the clear cell and borderline serious subtypes of ovarian carcinoma. Based on data from a number of international studies, there is a small increase in the risk of developing ovarian cancer in women who have severe menstrual pain.
It should be noted that there is a possibility that participants were unable to accurately recall their symptoms, and some women may have had undiagnosed endometriosis, both of which could have impacted the results of the study. A limitation of the study was the different questions regarding menstrual pain that was used at each specific site. The questions asked about severe or significant pain, and researchers were unable to evaluate milder pain. While the study included a large number of participants, most were white women (87%), which questions whether or not the results can be generalized to other ethnic groups.
Written By: Kimberly Spencer B.Sc. (Hons)
Reference: Babic, A., Harris, H., Vitonis, A., Titus, L., Jordan, S., & Webb, P. et al. (2017). Menstrual pain and risk of epithelial ovarian cancer: Results from the Ovarian Cancer Association Consortium. International Journal Of Cancer, 142(3), 460-469. http://dx.doi.org/10.1002/ijc.31010