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.

• Inflammation

  PURPOSE: Blood cells play a major role in homeostasis and inflammation. Primary dysmenorrhea (PD) involves the production of prostaglandins and leukotrienes, which cause inflammation in uterine tissue. [ncbi.nlm.nih.gov]

  […] are trying to call the white blood cells by causing an inflammation. [study.com]

• 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]

• Lower Abdominal Pain

  Introduction Definition dysmenorrhea is painful menses primary dysmenorrhea crampy, lower abdominal pain occurring during menses without any clear disease that can explain the symptoms secondary dysmenorrhea pain can be explained by other conditions [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]

  These symptoms include sharp lower abdominal pains that come and go in waves, as well as lower back pain, headaches, nausea and possibly constipation or diarrhea. [study.com]

  The pain usually begins when menses start (or just before) and persists for the first 1 to 2 days; this pain, described as spasmodic, is superimposed over constant lower abdominal pain, which may radiate to the back or thigh. [msdmanuals.com]

  SYMPTOMS OF ENDOMETRIOSIS IN YOUNG WOMEN Common symptoms in women with endometriosis include dysmenorrhea, lower abdominal pain and dyspareunia. Almost half of women with endometriosis also report their inability to become pregnant. [ncbi.nlm.nih.gov]

• Dyspepsia

  The NSAIDs are recommended for use in any woman with primary dysmenorrhea who may not want therapy with OCs and who does not have a history of peptic ulcer, dyspepsia, hepatic or renal disease, aspirin allergy, asthma, or a bleeding diathesis. [ncbi.nlm.nih.gov]

  However, these can gave side effects such as nausea, peptic ulcer, dyspepsia, and diarrhea. The use of oral contraception and hormone medication is also recognized to relieve symptoms of primary dysmenorrhea. [medicalterms.info]

  Laparoscopy may be required. [2] Management [ edit ] NSAIDs [ edit ] Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, are effective in relieving the pain of primary dysmenorrhea. [15] They can have side effects of nausea, dyspepsia [en.wikipedia.org]

• Leg Pain

  Symptoms may include backache, leg pain, nausea, vomiting, diarrhea, headache, and dizziness. This kind of dysmenorrhea usually affects young woman within two years of the onset of menstruation and lasts one or two days each month. [healthcentral.com]

  Symptoms of dysmenorrhoea Symptoms of dysmenorrhoea can include: pain low in the abdomen that can spread to the lower back and legs pain that is gripping or experienced as a constant ache, or a combination of both. [betterhealth.vic.gov.au]

  […] cycles May have associated backache, leg pains, nausea, vomiting, light-headedness and headache Physical examination is usually benign except for mild suprapubic tenderness. [pedclerk.bsd.uchicago.edu]

  Pain was assessed in: abdomen, legs, head and lower back. [nature.com]

  It may be helpful to teach patients the mnemonic ACHES: abdominal pain, chest pain, headache, eye/vision changes, and severe leg pain. [uspharmacist.com]

• Hyperactivity

  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 primary dysmenorrhea, the underlying basis is myometrial hyperactivity which causes local hypoxia due to an increased local secretion of vasopressin and prostaglandins. 3 The causes of secondary dysmenorrhea are diverse: intrauterine pathology (eg, [dovepress.com]

  During menstruation in the nondysmenorrheic woman, the uterine resting tone is lowest ( 4, 5, 11, 15, 16 In dysmenorrheic women, the increased release of uterine prostaglandins produces a significant degree of myometrial hyperactivity that results in [glowm.com]

• Dysmenorrhea

  Auricular acupressure therapy decreased abdominal pain, back pain, and primary dysmenorrhea of female high school students in South Korea. [ncbi.nlm.nih.gov]

• Vaginal Discharge

  discharge If something just seems wrong. [consumer.healthday.com]

  Any features suggestive of underlying pathology (eg, vaginal discharge, intermenstrual or postcoital bleeding, dyspareunia). Dyschezia and/or rectal pain or bleeding - particularly suggestive of endometriosis. [patient.info]

  The following findings are of particular concern: New or sudden-onset pain Unremitting pain Fever Vaginal discharge Evidence of peritonitis Red flag findings suggest a cause of pelvic pain other than dysmenorrhea. [msdmanuals.com]

  Aside from possible vaginal brownish discharge or bleeding, pelvic examination findings are normal. It is the emergency physician’s responsibility to ensure adequate analgesia and appropriate follow-up with a gynecologist. [emedicine.medscape.com]

• Uterine Hemorrhage

  In addition, it is characteristic of primates and is defined as cyclic uterine hemorrhage dependent on endometrial disintegration and exfoliation, which occurs approximately in a normal cycle of 21 to 45 days, with 2 to 6 days of flow and mean blood loss [scielo.br]

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.

Menstruation-related symptoms were found to be decreased after treatment and in the following cycle with both treatments (p 0.05). [ncbi.nlm.nih.gov]

Supportive treatment heat packs exercise NSAIDS (prostaglandin inhibitors) ibuprofen naproxen Hormonal therapy estrogen-progestin contraceptives are first-line ( e.g ., OCP, transdermal patch, vaginal ring) progestin-only contraceptives may also be used Prognosis [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]

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]

Clinical suspicion of another etiology if there is a history of pelvic inflammatory disease (PID), menorrhagia, and inter-menstrual bleeding. [pedclerk.bsd.uchicago.edu]

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]

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]

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]

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]

Dysmenorrhea Prevention The key to preventing dysmenorrhea is adapting a healthy lifestyle. [medicalterms.info]

Prevention: Dysmenorrhea may be prevented by treatment of the underlying cause. [rxmed.com]

[…] treatment heat packs exercise NSAIDS (prostaglandin inhibitors) ibuprofen naproxen Hormonal therapy estrogen-progestin contraceptives are first-line ( e.g ., OCP, transdermal patch, vaginal ring) progestin-only contraceptives may also be used Prognosis, Prevention [step2.medbullets.com]

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