Total Ovarian Volume and Multidimensional Pain in Primary Dysmenorrhea: A Cross-Sectional Ultrasound Study

Background/Objectives: The relationship between ovarian morphology and primary dysmenorrhea is poorly defined. We examined whether total ovarian volume (TOV) differs by dysmenorrhea status and is associated with multidimensional pain burden. Methods: This cross-sectional study included 118 nulliparous women aged 18–24 years, grouped by worst menstrual pain on a 0–10 visual analog scale (VAS ≥ 2, n = 76; control, n = 42). Pain was assessed with the Short-Form McGill Pain Questionnaire (SF-MPQ), and transabdominal ultrasonography was performed on cycle days 2–5. Results: Median TOV was higher with dysmenorrhea (17.04 [12.30–23.48] vs. 11.61 [9.00–15.72] cm3; p < 0.001). Sensory (17.0 [10.0–21.0] vs. 4.0 [1.0–8.0]), affective (4.0 [2.0–6.0] vs. 0.0 [0.0–2.0]), and total SF-MPQ scores (20.0 [13.2–27.0] vs. 4.5 [1.0–10.2]) were all higher (p < 0.001 for each). Each 5 cm3 increase in TOV was associated with higher odds of dysmenorrhea after adjustment for clinical covariates (odds ratio 1.764, 95% CI 1.270–2.681; p = 0.003), although discrimination was modest (area under the curve 0.718). The association was attenuated when restricted to women with bilateral ovarian volumes ≤ 10 cm3. Conclusions: Higher TOV accompanied greater multidimensional pain, but the association was not robust to exclusion of larger ovaries and requires external validation.