Impact of Dysmenorrhea Severity on Mental Wellbeing and Quality of Life Among Saudi Women: A Cross-Sectional Study

<i>Background and Objectives:</i> Dysmenorrhea affects 50-90% of women worldwide and significantly impacts quality of life. This study aimed to determine the nationwide prevalence of dysmenorrhea among Saudi women and evaluate the independent associations between pain severity, associated symptoms, and mental health and quality of life outcomes. <i>Materials and Methods:</i> A cross-sectional study was conducted between May and August 2024 among women aged 18-55 years in Saudi Arabia. Data were collected through an online survey assessing sociodemographic characteristics, menstrual patterns, dysmenorrhea severity (Visual Analogue Scale, VAS 1-10), associated symptoms, mental health (DASS-21), and quality of life (MQLI). Univariate comparisons and multiple linear regression analyses were performed to identify independent predictors of depression, anxiety, stress, and quality of life (QoL). <i>Results:</i> Of 950 women (mean age 28 ± 9.5 years, BMI 24 ± 5.8 kg/m²), 87% reported dysmenorrhea, with 50% experiencing pain every cycle and 55% reporting severe pain (VAS 7-10). Women with severe pain exhibited depression scores 47% higher than those with mild pain (21.8 vs. 14.8, <i>p</i> < 0.001), with similar patterns for anxiety and stress. In multivariate analyses, severe pain (VAS 8-10) was associated with 7-11-point increases in DASS scores (all <i>p</i> < 0.001). Constipation emerged as the strongest symptom-related predictor of depression (β = 4.94, <i>p</i> < 0.001), anxiety (β = 4.79, <i>p</i> < 0.001), stress (β = 3.96, <i>p</i> < 0.001), and reduced quality of life (β = -0.45, <i>p</i> = 0.015). Risk factors included having children, higher BMI, and longer menstrual cycles, while higher income, later menarche, and greater education were protective. <i>Conclusions:</i> Pain severity, not dysmenorrhea presence alone, drives mental health burden. Constipation represents a novel therapeutic target. Integrated care addressing pain, gastrointestinal symptoms, and mental health is essential.