Association between body mass index and dysmenorrhea in women with endometriosis: a systematic review and meta-analysis

Background: Dysmenorrhea is a debilitating symptom in patients with endometriosis, contributing significantly to disease burden. While the relationship between body mass index (BMI) and dysmenorrhea in these patients is unclear, emerging evidence suggests BMI may be correlated with pain in the presence of endometriosis. Objective: This systematic review and meta-analysis aimed to evaluate the association between BMI and dysmenorrhea in women with endometriosis. Search Strategy: We systematically searched PubMed, Scopus, Web of Science, and Google Scholar from inception to November 15, 2024. Selection criteria: Eligible studies for this review included original observational articles reporting outcomes related to the prevalence of dysmenorrhea in relation to body weight in patients with confirmed endometriosis. Data collection and analysis: Data for a two-way contingency table were extracted from the articles, and odds ratios (ORs) for the association between BMI categories and dysmenorrhea were calculated. These individual ORs were pooled using a random-effects model. Main results: Six studies involving 2,274 women with endometriosis were included. The meta-analysis revealed that underweight individuals with endometriosis had significantly higher odds of experiencing dysmenorrhea compared to non-underweight patients (OR = 1.38, 95% CI = 1.05 to 1.80, I² = 0.00%) or to those with normal weight (OR = 1.39, 95% CI = 1.05 to 1.83, I² = 0.00%). No significant association was found between dysmenorrhea and overweight or obese individuals. Sensitivity analyses showed variability in the findings based on the exclusion of certain studies. No publication bias was detected in the analysis. Conclusions: There was an association between underweight status and dysmenorrhea in endometriosis. We speculate that managing weight and nutrition may be useful in mitigating dysmenorrhea symptoms. However, due to the study limitations, prospective trials are needed to test the ability of diet to alleviate pain.