Association of Body Mass Index and Dysmenorrhea: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background: Dysmenorrhea or menstrual pain is a commonly occurring disorder in reproductive age women with different proposed risk factors, including body mass index. Objective: This study aimed to investigate the association between body mass index and dysmenorrhea using a systematic review and meta-analysis approach. Methods: Academic databases Scopus, PubMed CENTRAL, Embase, ProQuest, Science Direct, and ISI Web of Science, and Google Scholar- were searched systematically from inception until the end of February 2020. Original researches published in English with observational designs were included to examine the association of body mass index and dysmenorrhea as the primary outcome. Newcastle Ottawa scale was used to evaluate the methodological quality of the studies. Due to the variation of reported data across studies, all data were converted to Pearson correlation coefficient and corrected by transforming to fisher’s Z score. Then meta-analysis was performed using a random-effects model with Der-Simonian and Laird method. Results: A total of 61 studies with 57,079 participants, of which 25,044 reported having dysmenorrhea, were included. While publication bias was probable, results were corrected using the fill & trim method. The updated results based on this method showed that pooled Fisher’s z-score for the association of body mass index and dysmenorrhea was 0.04 (95% CI: -0.009; 0.085). The pooled estimated effect size of correlation showed a trivial to slight correlation between body mass index and dysmenorrhea with corrected fisher’s z score of 0.12 (95% CI: 0.08; 0.17, I2=95%). Conclusion: No association was found between body mass index and dysmenorrhea. But this finding should be interpreted with caution considering the included studies' limitations.