ArticlesMenstrual pain is associated with rapid structural alterations in the brainTu, Cheng-Haoa,b,c; Niddam, David M.a,b,d; Yeh, Tzu-Chena,b,e; Lirng, Jiing-Fenge; Cheng, Chou-Mingb; Chou, Chih-Cheb; Chao, Hsiang-Taif,g,**; Hsieh, Jen-Chuena,b,h,*Author Information aInstitute of Brain Science, National Yang-Ming University, Taipei, Taiwan bIntegrated Brain Research Unit, Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan cDepartment of Education and Research, Taipei City Hospital, Taipei, Taiwan dBrain Research Center, Department of Research and Development, National Yang-Ming University, Taipei, Taiwan eDepartment of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan fDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan gDepartment of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan hCenter for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan * Corresponding author. Address: Institute of Brain Science, National Yang-Ming University, Laboratory of Integrated Brain Research, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Rd., Taipei 112, Taiwan. Tel.: +886 2 28757480, +886 2 28267906; fax: +886 2 28745182. ** Co-corresponding author. Address: Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, No. 201, Sect. 2, Shih-Pai Rd., Taipei 112, Taiwan. Tel.: +886 2 28757826x205; fax: +886 2 77232788. E-mail addresses:email@example.com, firstname.lastname@example.org, email@example.com Article history: Received 26 July 2012 Received in revised form 27 March 2013 Accepted 10 May 2013 Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Pain: September 2013 - Volume 154 - Issue 9 - p 1718-1724 doi: 10.1016/j.pain.2013.05.022 Buy Metrics Abstract Summary One to 3 days of menstrual pain is associated with rapid gray matter alterations in the brain. ABSTRACT Dysmenorrhea is the most prevalent gynecological disorder in women of child-bearing age. Dysmenorrhea is associated with central sensitization and functional and structural changes in the brain. Our recent brain morphometry study disclosed that dysmenorrhea is associated with trait-related abnormal gray matter (GM) changes, even in the absence of menstrual pain, indicating that the adolescent brain is vulnerable to menstrual pain. Here we report rapid state-related brain morphological changes, ie, between pain and pain-free states, in dysmenorrhea. We used T1-weighted anatomic magnetic resonance imaging to investigate regional GM volume changes between menstruation and periovulatory phases in 32 dysmenorrhea subjects and 32 age- and menstrual cycle-matched asymptomatic controls. An optimized voxel-based morphometry analysis was conducted to disclose the possible state-related regional GM volume changes across different menstrual phases. A correlation analysis was also conducted between GM differences and the current menstrual pain experience in the dysmenorrhea group. Compared with the periovulatory phase, the dysmenorrhea subjects revealed greater hypertrophic GM changes than controls during the menstruation phase in regions involved in pain modulation, generation of the affective experience, and regulation of endocrine function, whereas atrophic GM changes were found in regions associated with pain transmission. Volume changes in regions involved in the regulation of endocrine function and pain transmission correlated with the menstrual pain experience scores. Our results demonstrated that short-lasting cyclic menstrual pain is associated not only with trait-related but also rapid state-related structural alterations in the brain. Considering the high prevalence rate of menstrual pain, these findings mandate a great demand to revisit dysmenorrhea with regard to its impact on the brain and other clinical pain conditions. © 2013 Lippincott Williams & Wilkins, Inc.