Menstrual-Associated Gastrointestinal Symptoms and Their Impact on IBS Diagnosis in Adolescents

Irritable bowel syndrome (IBS) is the most frequent abdominal-pain-predominant disorder of gut-brain interaction (DGBI). Because the pediatric Rome IV criteria require abdominal pain and stool changes for at least 4 days per month over 2 months, adolescents whose pain coincides with menstruation may be misclassified as IBS. We aimed to determine whether menstrual-associated gastrointestinal symptoms contribute to the reported IBS prevalence.

We conducted a cross-sectional study of 3521 school-aged females (10-16 years) from public and private schools in Colombia. Participants completed the validated Spanish Rome IV Pediatric Questionnaire for Gastrointestinal Symptoms, which included questions on temporal relation between pain, bowel habits, and menstruation. These symptoms were defined as occurring during days of active bleeding, without inclusion of a pre- or postmenstrual window.

Of 3336 analyzable surveys (mean age 13.3 ± 1.8 years), 2926 (87.7%) were postmenarcheal. Overall, 609/2926 (20.8%) met criteria for ≥ 1 DGBI, including 45 participants (1.5%) who met criteria for IBS. Among postmenarcheal participants with IBS, 62.2% reported abdominal pain and bowel-habit changes exclusively during menstruation.

A substantial proportion of adolescents meeting pediatric Rome IV criteria for IBS reported symptoms confined to menstruation, demonstrating a clinically relevant diagnostic overlap between dysmenorrhea and IBS. Because the Rome IV pediatric algorithm does not distinguish menstrual-only pain from chronic abdominal pain, menstrual-associated gastrointestinal symptoms may resemble those of IBS and complicate diagnostic decision-making. Further studies are needed to clarify whether these presentations reflect menstrual-related gastrointestinal symptoms alone or a distinct subset of DGBI.