Which of the following are risk factors for dysmenorrhea?

• A. Smoking, stress, young age, and nulliparity.
• B. Advanced age and multiparity
• C. High calcium intake
• D. Regular exercise

Answer: (A)

Dysmenorrhea risk is driven by factors that boost prostaglandin-driven uterine contractions and influence how pain is perceived. Young age is a common risk because primary dysmenorrhea often begins with menarche and is most prevalent in adolescents, with symptoms frequently easing with age or after childbirth. Not having had a pregnancy, or nulliparity, is linked to higher risk since parity seems to modulate uterine contractility and inflammatory pathways involved in menstrual cramps. Smoking contributes by increasing prostaglandin production and causing vasoconstriction, which can worsen uterine ischemia during menses. Stress can amplify pain perception and may alter hormonal or inflammatory responses related to menstruation. Put together, these factors create a profile where cramps are more likely and more intense.

In contrast, advanced age and having had multiple pregnancies generally reduce the risk of dysmenorrhea, high calcium intake isn’t established as a risk factor, and regular exercise tends to lessen symptoms rather than increase risk.