Dysmenorrhea
Dysmenorrhea was found in 5-Minute Clinical Consult which helps you diagnose, treat, and follow up on over 900 medical conditions seen in everyday practice.

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Basics

Description

  • Pelvic pain occurring at/around the time of menses; a leading cause of absenteeism for women <30 years
  • Primary dysmenorrhea: Without pathologic physical findings
  • Secondary dysmenorrhea: Often more severe than primary, having a secondary pathologic (structural) cause
  • Classified by severity:
    • Mild: Pelvic discomfort, cramping, or heaviness on 1st day of bleeding, with no associated symptoms
    • Moderate: Discomfort occurring during 1st 2–3 days of menses, accompanied by mild malaise, diarrhea, and headache
    • Severe: Intense, cramp-like pain lasting 2–7 days, often with nausea, diarrhea, back pain, thigh pain, and headache
  • System affected: Reproductive
  • Synonym(s): Menstrual cramps

Epidemiology

  • Predominant age:
    • Primary: Teens to early 20s
    • Secondary: 20s–30s
  • Predominant sex: Women only
Prevalence
  • 43–91% of adolescent females have primary dysmenorrhea (1).
  • 16–67% decreased prevalence in women >18 years of age (1)
  • 10–30% of women who work/study lose 1–2 work/school days/month in the US (1).

Risk Factors

  • Primary:
    • Cigarette smoking
    • Alcohol use
    • Depression
    • Weight Loss
    • Early menarche
    • Irregular/Heavy menstrual flow
  • Secondary:
    • Pelvic infection
    • Use of intrauterine device (IUD)
    • Structural pelvic malformations

Genetics
Not well studied

General Prevention

  • Primary: Choose a diet low in animal fats.
  • Secondary: Reduce risk of STIs

Pathophysiology

See “Etiology.”

Etiology

  • Primary: Elevated production of prostaglandins (PGF2α) through indirect hormonal control (stimulation of production by estrogen) which causes hypercontractility and increased uterine muscle tone with resultant uterine ischemia. Ischemia results in type C pain neuron stimulation through buildup of anaerobic metabolites.
  • Secondary:
    • Congenital abnormalities of uterine/vaginal anatomy
    • Cervical stenosis
    • Pelvic infection
    • Adenomyosis
    • Endometriosis
    • Pelvic tumors, especially leiomyomata (fibroids)
    • Uterine polyps
    • Use of IUD

Pediatric Considerations
Onset with 1st menses raises probability of genital tract anatomic abnormality, such as transverse vaginal septum, minimally perforated hymen, and uterine anomalies.

Commonly Associated Conditions

  • Irregular/Heavy menstrual periods
  • Longer menstrual cycle length/duration of bleeding

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