Prevalence and associated factors of primary dysmenorrhea among women in sub-Saharan Africa: a systematic review and meta-analysis.

Primary dysmenorrhea, painful menstruation without underlying pelvic pathology, is a prevalent gynecological issue affecting adolescents and young women. Despite its high burden in Sub-Saharan Africa, regional estimates of prevalence and associated factors remain limited. This systematic review and meta-analysis aimed to synthesize evidence on the prevalence and determinants of primary dysmenorrhea among women in Sub-Saharan Africa. A comprehensive search of PubMed, Scopus, HINARI, Web of Science, Google Scholar, and university repositories was conducted for studies published between 2008 and 2025. Cross-sectional studies reporting prevalence and/or associated factors of primary dysmenorrhea among SSA women were included. Data extraction and quality appraisal followed the Joanna Briggs Institute tools. Pooled prevalence and associations were estimated using random- or fixed-effects models in STATA 17, with heterogeneity assessed using I², Cochrane Q-test, and publication bias assessed using funnel plots, and Egger’s test. Sixty-five studies with 28,813 participants from 12 Sub-Saharan African countries were analyzed. The pooled prevalence of primary dysmenorrhea was 73.49% (95% CI: 70.95–76.03). Significant predictors included family history of dysmenorrhea (OR = 5.20; 95% CI: 3.28–7.12), irregular menstrual cycles (OR = 2.57; 95% CI: 1.67–3.48), and short cycle length (< 21 days; OR = 3.31; 95% CI: 1.88–5.83), whereas sexual intercourse was associated with lower odds (OR = 0.39; 95% CI: 0.11–0.68). Subgroup analyses indicated variation across countries, and sensitivity analyses confirmed robustness. Primary dysmenorrhea affects nearly three-quarters of women in Sub-Saharan Africa and is influenced by family history of dysmenorrhea, irregular menstrual cycles, short cycle length, and sexual intercourse.