Dysmenorrhea and polycystic ovarian morphology (PCOM) are prevalent gynecological conditions with significant impacts on quality of life. Although traditionally viewed as separate entities, emerging evidence suggests a potential association. This study assessed the prevalence and severity of dysmenorrhea among individuals with PCOM and identified risk factors for severe dysmenorrhea.

We conducted a retrospective observational study at a gynecologic ultrasound clinic in Hamilton, Canada, including patients aged 20–45 years diagnosed with PCOM between February and June 2023. PCOM was defined by ≥20 follicles and/or ovarian volume >10 mL without a dominant follicle, cyst, or corpus luteum. Dysmenorrhea severity was self-reported via a visual analogue scale (VAS; 0–10), with VAS ≥ 6 indicating severe dysmenorrhea. Statistical analyses included univariate comparisons and logistic regression.

Among 1,321 scans, 243 patients (18%) had PCOM; 208 met inclusion criteria. Severe dysmenorrhea was reported by 61% (127/208). Univariate analysis linked severe dysmenorrhea with younger age, higher weight, heavy menstrual flow, dyspareunia, and infertility history; gravidity and previous pregnancies were protective. Logistic regression identified heavy menstrual flow (OR 16.32; p < 0.001) and referral for advanced endometriosis ultrasound (OR 4.34; p = 0.021) as independent risk factors, while gravidity was protective (OR 0.38; p = 0.016).

Nearly 1 in 5 patients undergoing gynecologic ultrasound presented with PCOM, and a majority reported severe dysmenorrhea. Heavy menstrual flow and gravidity emerged as key factors influencing severity. These findings underscore the importance of targeted clinical assessment and raise questions about PCOM as a contributor to menstrual pain independent of polycystic ovary syndrome.