Cramps or Cancer: Elevated Menstrual Pain May be Associated with Ovarian Cancer Risk

Menstrual pain is something that, unfortunately, many women will encounter at some point during their lives. However, according to a recent study published in the International Journal of Cancer, individuals may want to talk to their health care providers if they consistently experience severe menstrual pain, as it may be linked to ovarian cancer.

Researchers reviewed the cases of more than 20,000 women — some who went on to develop ovarian cancer, and some who didn’t – and found that there was a small, but statistically significant increase in ovarian cancer incidence in women who reported having severe menstrual pain.

CURE spoke with one of the study authors, Ana Babic, Ph.D., of the Dana-Farber Cancer Institute, to unpack these findings.

Can you briefly explain why you wanted to conduct this research, and what your findings were?

Ovarian cancer is a deadly disease with less than 50 percent of women surviving five years after diagnosis. One of the reasons for the high mortality is that ovarian cancer is often diagnosed at a late stage, when cancer has spread outside the ovary and treatment options are of limited efficacy. It is therefore crucial to identify risk factors and warning signs in order to identify women at high risk of ovarian cancer who might benefit from more frequent screening.

In our previous study of 2,028 women with ovarian cancer and 2,091 women without ovarian cancer participating in the New England Case Control study, published in 2014, we observed that women with moderate and severe menstrual pain have higher risk of ovarian cancer than women that reported having no pain or only mild pain.

Intrigued by those results, we decided to validate those results in a much larger study that consisted of 10,592 women with, and 13,320 women without ovarian cancer across nine study sites from Australia, Europe and the United States. We again observed a small, but statistically significant increase in risk of ovarian cancer in women with severe menstrual pain. More precisely, we observed a 7 percent higher risk of ovarian cancer in women with severe menstrual pain than those without severe pain. Importantly, increased risk was observed in all the study sites, suggesting that this is a robust finding.

Is or was there a common belief that menstrual pain throughout a woman’s life was indicative of cancer?

There is no common belief that menstrual pain indicates cancer, but prior studies have shown that women who report severe menstrual pain are at increased ovarian cancer risk.

However, we should make the distinction that menstrual pain is not thought to be a marker for a growing cancer, but may be indicative of processes that increase cancer risk. For example, menstrual cramps during period occur because inflammatory molecules, such as prostaglandins, trigger contractions of the uterus. Several studies have suggested that women with more intense menstrual cramps have higher levels of inflammation during their periods. Furthermore, inflammation has been shown to play an important role in ovarian tumor development.

We, therefore, hypothesized that women with stronger menstrual pain might be at higher risk of ovarian cancer. Another important cause of menstrual pain is endometriosis, which has been associated with increased ovarian cancer risk. In our study we asked women whether they were diagnosed with endometriosis and were, therefore, able to look at menstrual pain independent of endometriosis, in relation to ovarian cancer. The results of our study suggest that menstrual pain might be indeed independently associated with ovarian cancer.

We were not surprised at those findings since our previous, although smaller study, has shown similar results.

Many, if not most, women experience menstrual pain at some point in their life. At what point does it become a health issue that they should talk to their doctor about?

This is an important question, but our study does unfortunately not offer an answer. We believe that women concerned with menstrual pain should discuss it with their doctor. We hope that results of our research will raise interest in research of menstrual pain, and encourage further studies that will investigate on a molecular level the link between menstrual pain and ovarian cancer. Only then we will be able to make recommendations related to when is menstrual pain a warning sign, and what should be done about it.

What are unanswered questions in this field, as well as next steps in research?

While results of our study suggest a robust link between ovarian cancer and severe menstrual pain, we still need to determine the precise molecular mechanism that links menstrual pain to ovarian cancer. If there proves to be a biologic mechanism that lends itself to intervention (for example, elevated levels of certain inflammatory molecules during severe menstrual cramping cause ovarian cancer), we could find ways to screen women with severe menstrual pain for early ovarian cancer, and identify ways to block those inflammatory molecules in women with severe menstrual pain.

Is there anything else you’d like to mention to our patient audience?

Even severe menstrual pain is commonly dismissed as “normal” physiological process. While our study does not prove that menstrual pain is causing ovarian cancer, it certainly indicates there is a link between the two, and warrants more research efforts in order to understand its consequence on women’s health.