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Primary Dysmenorrhea

Primary dysmenorrhea is a common problem in menstruating women, starts at menarche and typically affects adolescents. It is characterized by pain in the lower abdomen or the pelvis region, beginning prior to the onset or during menstruation without any predisposing underlying conditions like endometriosis. A detailed history and findings on physical examination are sufficient to confirm the diagnosis.


Presentation

Dysmenorrhea is defined as painful menstruation. It can be either primary or secondary. Primary dysmenorrhea occurs in the absence of any identifiable causes such as endometriosis. It affects approximately 90% of menstruating women [1] and begins within a few months to a year after the onset of menarche [2]. Patients present with pelvic or lower abdominal spasmodic type of pain with or without radiation to the lower limbs or back at the beginning of menstruation [3] [4] [5] [6] [7] [8] [9] [10] [11] [12]. The pain can last from a few hours to up to four days and is often accompanied by a lower back pain, headache, nausea, vomiting, diarrhea, malaise, and fatigue [2]. This affects the quality of life and can interfere with daily activities like school, studies or work in approximately 5% of the affected females. Severe symptoms are noticed in patients with early onset of menarche, heavy menstrual bleeding, and the habit of smoking. The typical signs usually diminish as age advances and following pregnancy. There is no family history associated with this disorder.

Primary dysmenorrhea can be distinguished from secondary dysmenorrhea by the following features:

  • a family history of dysmenorrhea and endometriosis indicates secondary dysmenorrhea
  • an onset of symptoms within months of the menarche is indicative of primary dysmenorrhea.
Turkish
  • OBJECTIVE: This study aims to investigate the possible role of vitamin D deficiency in primary dysmenorrhea by assessing serum 25-hydroxyvitamin D 3 levels in a cohort which includes young Turkish women with primary dysmenorrhea and healthy controls.[ncbi.nlm.nih.gov]
Abdominal Obesity
  • CONCLUSION: The results suggest that healthy body mass and lack of abdominal obesity may reduce the risk of PD. 2018 Japan Society of Obstetrics and Gynecology.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Auricular acupressure therapy decreased abdominal pain, back pain, and primary dysmenorrhea of female high school students in South Korea.[ncbi.nlm.nih.gov]
  • She has nausea and vomiting during menses, but denies irregular or heavy periods, pain with intercourse, or abdominal pain outside of menses. Pelvic exam is normal.[step2.medbullets.com]
  • Primary dysmenorrhea is defined as lower abdominal pain that occurs during menses and is not secondary to any type of pelvic disease. It is considered the most common condition in reproductive age women.[clinicaltrials.gov]
Distractibility
  • Majority of dysmenorrheic females practiced staying in bed, having hot water bath, use of special food or drink to reduce pain and distraction by watching TV, reading etc. as a measure to relieve pain.[ncbi.nlm.nih.gov]
Hyperalgesia
  • […] the word 'dysmenorrhea' one or more of the following search terms were used to obtain articles published in peer-reviewed journals only: pain, risk factors, etiology, experimental pain, clinical pain, adenomyosis, chronic pain, women, menstrual cycle, hyperalgesia[ncbi.nlm.nih.gov]
Tremulousness
  • PD is defined as painful menses with cramping sensation in the lower abdomen that is often accompanied by other symptoms, such as sweating, headache, nausea, vomiting, diarrhea, and tremulousness.[ncbi.nlm.nih.gov]
Dysmenorrhea
  • BACKGROUND AND OBJECTIVES: Dysmenorrhea is commonly categorized into two types; primary and secondary. Primary dysmenorrhea (PD) is the focus of this review.[ncbi.nlm.nih.gov]

Workup

The diagnosis of primary dysmenorrhea depends on a detailed history and physical examination [3]. During the collection of anamnestic data, the physician should inquire about the onset, duration, progress and type of menstrual pain along with factors which aggravate or relieve the pain. A history of spasmodic, abdominal or pelvic cramps accompanying menstruation is typical of primary dysmenorrhea while a positive family history in first-degree relatives may be suggestive of endometriosis with secondary dysmenorrhea [2]. A thorough menstrual history should also be recorded. The physical examination, including pelvic and rectal examination, does not reveal any abnormalities in primary dysmenorrhea but it is essential to exclude secondary causes such as tumors or ovarian cysts. In adolescents who are sexually active, a pelvic examination should be performed to rule out pelvic inflammatory disease and a pregnancy test is also warranted. However, it should not be performed in adolescents with suspected primary dysmenorrhea who do not report a vaginal intercourse in the sexual history [13].

A trial of non-steroidal anti-inflammatory drugs (NSAIDs) with partial relief of pain is used to confirm the diagnosis of primary dysmenorrhea [14]. Failure to respond to the NSAIDs mandates further investigation with laparoscopy, laboratory tests and imaging studies [8]. Otherwise, no further evaluation is required in cases of primary dysmenorrhea.

Treatment

  • Collateral meridian acupressure therapy was performed once on the second day of both the first (partial treatment) and fourth (complete treatment) menstrual period.[ncbi.nlm.nih.gov]

Prognosis

  • ., OCP, transdermal patch, vaginal ring) progestin-only contraceptives may also be used Prognosis, Prevention, and Complications For women who complete 3 months of NSAIDs and/or hormonal therapy with no improvement, diagnostic laparoscopy is an option[step2.medbullets.com]
  • When there is secondary dysmenorrhea with an underlying condition contributing to the pain, the prognosis depends on the successful treatment of that underlying condition.[medicinenet.com]
  • Prognosis Symptoms can be controlled with treatment. Other Nothing specified.[rxmed.com]
  • Prognosis Medication should lessen or eliminate pain by the end of three menstrual cycles. If it does not work, then a re-evaluation is necessary. Prevention NSAIDs taken one to two days before a period begins should eliminate cramps for some women.[healthofchildren.com]
  • Prognosis Medication should lessen or eliminate pain. Prevention NSAIDs taken a day before the period begins should eliminate cramps for some women. Resources Periodicals McDonald, Claire, and Susan McDonald. "A Woman's Guide to Self-care."[medical-dictionary.thefreedictionary.com]

Etiology

  • Prostaglandins are thought by many as the etiologic agent of disease. The newest link of research deals with the implication of arginine vasopressin (AVP) as another possible integrated factor in the etiology of primary dysmenorrhea.[ncbi.nlm.nih.gov]
  • Pathophysiology Idiopathic with no clear pelvic pathology Contrast with Secondary Dysmenorrhea in which an underlying organic etiology is identified Uterine hyperactivity Increased myometrial resting tone 10 mmHg Increased contractile myometrial pressure[fpnotebook.com]
  • In combination with the word 'dysmenorrhea' one or more of the following search terms were used to obtain articles published in peer-reviewed journals only: pain, risk factors, etiology, experimental pain, clinical pain, adenomyosis, chronic pain, women[sri.com]

Epidemiology

  • Andersch B, Milsom I (1982) An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 144:655–660 PubMed Google Scholar 14.[link.springer.com]
  • Epidemiology Onset occurs within 6 to 12 months of Menarche (may occur as long as 2 years from Menarche in some women) Prevalence peaks around age 20 years Lifetime Prevalence of severe Dysmenorrhea : 50-60% Women incapacitated for 1-3 days of each cycle[fpnotebook.com]
  • An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol . 1982;144:655–60. 4. Sundell G, Milson I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhea in young women.[aafp.org]
Sex distribution
Age distribution

Pathophysiology

  • One of the combinations is widely used in Mexico (paracetamol, pyrilamine and pamabrom) and the selected comparison was a medication with naproxen sodium, paracetamol and pamabrom based on the pathophysiology of primary dysmenorrhea.[ncbi.nlm.nih.gov]
  • Pathophysiology Idiopathic with no clear pelvic pathology Contrast with Secondary Dysmenorrhea in which an underlying organic etiology is identified Uterine hyperactivity Increased myometrial resting tone 10 mmHg Increased contractile myometrial pressure[fpnotebook.com]
  • Pharmacotherapy: A Pathophysiologic Approach. Based on: DiPiro JT, Talbert RL, Yee GC, et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed.[uspharmacist.com]

Prevention

  • CONCLUSION: Further study is needed to determine whether effectively blocking dysmenorrheic pain ameliorates risk for the development of chronic pain disorders and to explore whether it is possible to prevent the development-and not just treat-severe[ncbi.nlm.nih.gov]
  • ., OCP, transdermal patch, vaginal ring) progestin-only contraceptives may also be used Prognosis, Prevention, and Complications For women who complete 3 months of NSAIDs and/or hormonal therapy with no improvement, diagnostic laparoscopy is an option[step2.medbullets.com]
  • Sildenafil citrate (Viagra) is an inhibitor that augments the vasodilatory effects of nitric oxide by preventing the degradation of Cyclic guanosine monophosphate (cGMP) in the uterine muscle.[clinicaltrials.gov]
  • View Article PubMed Google Scholar Kim JK, Kim Y, Na KM, Surh YJ, Kim TY: [6]-Gingerol prevents UVB-induced ROS production and COX-2 expression in vitro and in vivo. Free Radic Res. 2007, 41: 603-614. 10.1080/10715760701209896.[bmccomplementalternmed.biomedcentral.com]

References

Article

  1. Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. 1996;87:55–8.
  2. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332(7550):1134–1138.
  3. Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol. 2006;108(2):428–441.
  4. Fall M, Baranowski AP, Fowler CJ, et al. European Association of Urology. EAU guidelines on chronic pelvic pain. Eur Urol. 2004;46(6):681–689.
  5. Leyland N, Casper R, Laberge P, Singh SS. SOGC. Endometriosis: diagnosis and management. J Obstet Gynaecol Can. 2010;32(7 suppl 2): S1–S32.
  6. Saccardi C, Cosmi E, Borghero A, Tregneghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sono-vaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40(4):464–469.
  7. Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P. Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril. 2001;76(5):929–935.
  8. Hori Y. SAGES Guidelines Committee. Diagnostic laparoscopy guidelines. Surg Endosc. 2008;22(5):1353–1383.
  9. American Institute of Ultrasound in Medicine. AIUM practice guideline for the performance of pelvic ultrasound examinations. J Ultrasound Med. 2010;29(1):166–172.
  10. Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2011;37(3):257–263.
  11. Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2010 [published correction appears in MMWR Recomm Rep. 2011;60(1):18]. MMWR Recomm Rep. 2010;59(RR-12):1–110.
  12. Benagiano G, Brosens I, Carrara S. Adenomyosis: new knowledge is generating new treatment strategies. Womens Health (Lond Engl). 2009;5(3):297–311.
  13. Slap GB. Menstrual disorders in adolescence. Best Pract Res Clin Obstet Gynaecol. 2003;17(1):75–92.
  14. Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999 Aug 1;60(2):489-496

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Last updated: 2019-07-11 21:10