Documented adolescent dysmenorrhoea (period pain) and adolescent endometriosis in English general practice: prevalence and social patterns

Conference:

SAPC ASM 2023 - Brighton

Talk Code:

4B.9

Presenter:

Sharon Dixon

Co-authors:

Andrew Snelling, Tom Ranger, Katy Vincent, Julia Hippisley-Cox

Author institutions:

Nuffield Department of Primary Care Health Sciences, University of Oxford (SD, AS, TR, J-H-C), Nuffield Department of Women's and Reproductive Health, University of Oxford (KV)

Problem

Dysmenorrhoea affects up to 94% of teenagers who menstruate, with a third experiencing severe pain. Menstrual pain disrupts school and leisure activities, and may contribute to central pain sensitisation. Despite the existence of effective treatment, most teenagers don’t access medical care, although a recent English survey reported 29.5% of teenagers have seen doctors about periods.

Menstrual pain occurs in the absence of identifiable causes (primary dysmenorrhoea), but can also be a presenting symptom for other conditions (secondary dysmenorrhoea). Endometriosis is the commonest cause of secondary dysmenorrhoea in adolescents, but is believed to be under-recognised, with delays between presentation with symptoms and diagnosis.

Approach

To explore the prevalence of recorded dysmenorrhoea in adolescents accessing general practice in England, we undertook a descriptive epidemiologic study conducted within the QResearch database. QResearch is a validated database containing the anonymised GP health records of over 35 million individuals. We report the annual prevalence of recorded dysmenorrhoea amongst female-at-birth individuals aged 10-19 years in England between 1.1.2010-30.6.2021, stratified by age, region, ethnicity, and socio-economic status (SES).

Findings

In a cohort of 2,414,103 adolescents recorded as female in their GP records, 4.02% had documented dysmenorrhoea, and 0.8% had recorded endometriosis. The peak age for dysmenorrhoea was 16, whilst endometriosis diagnoses increased throughout adolescence. The annual prevalence of dysmenorrhoea and endometriosis did not fluctuate considerably throughout the study period.

We observe variation in the prevalence of both dysmenorrhoea and endometriosis by ethnicity and socio-economic status (SES). Using self-reported ethnicity from GP records, adolescents documented as white had a higher prevalence of recorded dysmenorrhoea, and a significantly higher rate of diagnosed endometriosis. Adolescents with a documented ethnicity other than white were 27% less likely to have documented dysmenorrhoea (OR 0.73 (0.71, 0.74), p < .001) and 72% less likely to have a documented diagnosis of endometriosis (OR 0.28 (0.23, 0.33), p < .001). There was some variability within this, for example, those with documented Caribbean ethnicity had the highest prevalence of dysmenorrhoea (6.32% cf. 4.34% for white adolescents). However, this did not translate into the highest prevalence of endometriosis diagnosis (0.05% cf 0.1% for white adolescents).

While there was no obvious pattern between prevalence and geographic region, the prevalence of recorded dysmenorrhoea and endometriosis in adolescence were both inversely socially patterned, reducing from the highest to lowest SES brackets.

Consequences

The prevalence of dysmenorrhoea in GP records is significantly lower than community surveys of symptom prevalence and health seeking suggest. The prevalence of diagnosed endometriosis in adolescence is low. There is differential prevalence of both dysmenorrhoea and endometriosis by ethnicity and SES, more marked for endometriosis. The relatively low levels of coding or healthcare seeking and discernible demographic patterns in this observational epidemiologic study warrant further exploration.

Submitted by:

Sharon Dixon

Funding acknowledgement:

This study was funded as part of Sharon Dixon’s NIHR Doctoral research fellowship NIHR301787. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.