For many young women across Europe, the onset of menstruation brings not just a biological milestone but the beginning of years of recurring pain. A new study published in The Lancet Child & Adolescent Health offers a potential way to identify those at risk before their first period even arrives.
Researchers analysed data from more than 2,000 adolescents and found that non-painful symptoms reported before menarche—such as fatigue, dizziness, gastrointestinal complaints, nightmares, or sensory changes—were strong indicators of future dysmenorrhoea, the medical term for painful menstruation. Advanced pubertal development at ages nine to ten also emerged as a significant predictor.
Why early identification matters
Dysmenorrhoea is one of the most common gynaecological complaints among adolescents, yet it is frequently dismissed as an inevitable part of growing up. The condition can disrupt school attendance, social life, and daily functioning, and it has been linked to a higher risk of chronic pain conditions later in life. Despite this, little is known about its risk factors, partly because most research begins after menstruation has already started.
“Identifying risk factors for dysmenorrhoea, especially severe dysmenorrhoea, has the potential to improve outcomes for female adolescents through early and more targeted treatment,” the authors wrote.
Previous studies have estimated that around 70% of female adolescents experience menstrual pain, and for about one in five, the pain significantly interferes with everyday activities. In countries like Germany, France, and the Nordic states, where school attendance is closely tied to academic progression, the impact can be particularly acute.
The role of sleep
The study also highlighted a strong association between sleep problems and the degree to which pain affects daily life. Adolescents who reported poor sleep before their first period were more likely to experience pain that interfered with their routines. The researchers suggest that addressing sleep disturbances early—perhaps through cognitive behavioural therapy, which has shown promise in adolescents with chronic pain—could help reduce both the sleep issues and the resulting pain interference.
This finding aligns with broader research on the bidirectional relationship between sleep and pain. In a continent where adolescent mental health and sleep quality have become growing concerns, the potential for a non-pharmacological intervention is particularly appealing.
The study’s authors hope that by identifying at-risk girls before menarche, healthcare providers across Europe—from paediatricians in Warsaw to school nurses in Lisbon—can offer earlier support. This could include lifestyle advice, sleep hygiene education, or more proactive pain management strategies once menstruation begins.
While the findings are observational and require further validation, they open the door to a more preventive approach in adolescent gynaecological care. For the millions of young women who currently suffer in silence, that would be a meaningful step forward.
