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Int J Cancer. 2018 Feb 1;142(3):460-469. doi: 10.1002/ijc.31010. Epub 2017 Sep 21.

Menstrual pain and risk of epithelial ovarian cancer: Results from the Ovarian Cancer Association Consortium.

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Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA.
Division of Public Health Sciences, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA.
Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH.
Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Department of Epidemiology, University of Washington, Seattle, WA.
Department of Population Health Sciences, University of Utah.
Cancer Prevention and Control, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
Department of Biomedical Sciences, Cedars-Sinai Medical Center, Community and Population Health Research Institute, Los Angeles, CA.
Division of Gynecologic Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Ovarian Cancer Center of Excellence, Womens Cancer Research Program, Magee-Womens Research Institute and University of Pittsburgh Cancer Institute, Pittsburgh, PA.
Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Buffalo, NY.
The University of Texas School of Public Health, Houston, TX.
Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA.
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC.
Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA.
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.


Menstrual pain, a common gynecological condition, has been associated with increased risk of ovarian cancer in some, but not all studies. Furthermore, potential variations in the association between menstrual pain and ovarian cancer by histologic subtype have not been adequately evaluated due to lack of power. We assessed menstrual pain using either direct questions about having experienced menstrual pain, or indirect questions about menstrual pain as indication for use of hormones or medications. We used multivariate logistic regression to calculate the odds ratio (OR) for the association between severe menstrual pain and ovarian cancer, adjusting for potential confounders and multinomial logistic regression to calculate ORs for specific histologic subtypes. We observed no association between ovarian cancer and menstrual pain assessed by indirect questions. Among studies using direct question, severe pain was associated with a small but significant increase in overall risk of ovarian cancer (OR = 1.07, 95% CI: 1.01-1.13), after adjusting for endometriosis and other potential confounders. The association appeared to be more relevant for clear cell (OR = 1.48, 95% CI: 1.10-1.99) and serous borderline (OR = 1.31, 95% CI: 1.05-1.63) subtypes. In this large international pooled analysis of case-control studies, we observed a small increase in risk of ovarian cancer for women reporting severe menstrual pain. While we observed an increased ovarian cancer risk with severe menstrual pain, the possibility of recall bias and undiagnosed endometriosis cannot be excluded. Future validation in prospective studies with detailed information on endometriosis is needed.


case-control studies; inflammation; menstrual pain; ovarian cancer

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