Association of Body Mass Index, Hemoglobin Level, and Stress Level with the severity of Dysmenorrhea among Female Patients Attending Al-Kadhimayn Teaching Hospital, Baghdad: Cross-sectional study

Abstract

Background: Dysmenorrhea is a common menstrual complaint among women of reproductive age and can interfere with daily activities, work, and quality of life. Several factors have been associated with dysmenorrhea, including body mass index (BMI), hemoglobin level, and perceived stress. Aim: To examine the relationship between BMI, hemoglobin level, perceived stress, and the occurrence of dysmenorrhea among female patients attending the gynecology outpatient clinic of Al-Kadhimayn Teaching Hospital, Baghdad. Methods: An observational analytic cross-sectional study was conducted among 180 female patients selected through systematic random sampling from the clinic register. Data were collected using a structured interview that included demographic and lifestyle characteristics, anthropometric measurements, capillary hemoglobin testing, and the Arabic-validated 10-item Perceived Stress Scale (PSS-10) [16]. BMI was categorized into three groups: underweight, normal weight (reference), and overweight. Chi-square tests and binary logistic regression were used for statistical analysis. Result: Dysmenorrhea was reported by 67.8% of the participants. Nutritional status, hemoglobin status, and perceived stress were significantly associated with dysmenorrhea (p < 0.05). The logistic regression model had a Nagelkerke R² of 0.518, indicating that the included factors explained 51.8% of the variation in dysmenorrhea. Compared with normal-weight participants, both underweight (adjusted OR = 4.31, 95% CI: 1.31–14.18) and overweight participants (adjusted OR = 8.57, 95% CI: 2.71–27.07) had significantly higher odds of dysmenorrhea, with the strongest association observed among those who were overweight. Anemia (adjusted OR = 4.64) and high perceived stress (adjusted OR = 3.92) were also independently associated with dysmenorrhea. Conclusion: In this single-center sample, underweight and overweight status, anemia, and high perceived stress were statistically associated with dysmenorrhea. However, because of the cross-sectional design, these associations should not be interpreted as causal. Longitudinal and multicenter studies are recommended to clarify the temporal relationships and clinical relevance of these factors.