Psychological challenges and the relationship between menstrual pain severity and daily life interference in young adult women: A cross-sectional analysis of a population-based birth cohort

Menstrual pain is common and disrupts daily life. How psychological challenges influence this association remains unclear. This study examined associations between self-rated menstrual pain and functional interference, and explored the moderating and mediating roles of psychological challenges (Strengths and Difficulties Questionnaire; SDQ), in a Dutch population-based cohort with 876 young adult women (19–21 years). Multivariable logistic regression and conditional effects analyses showed that each unit increase in pain severity was associated with high functional interference: 61%, 60%, and 53% increased odds for school, work and social activity interference, respectively. Psychological challenges moderated associations mainly for work attendance and sports, with weaker positive associations at greater challenges. Small mediation effects were found for total psychological challenges across all domains, and for the emotional problems and hyperactivity/inattention across some interference domains. Findings highlight the need for (longitudinal) research to clarify the role of psychological challenges to inform future interventions mitigating functional interference.