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GeneralConsiderations|Primary&PreventiveAmbulatoryHealthCare|Obstetrics|Gynecology|REI|Oncology
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ReproductiveEndocrinology>MenstrualandEndocrineDisorders>Dysmenorrhea

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Classificationofdysmenorrhea
Causesofprimarydysmenorrhea
Roleofprostaglandinsynthaseinhibitors

Classificationofdysmenorrhea
Contributor:BethMalizia,M.D.
Reviewer:SejalDharia,M.D.

Dysmenorrheaorpainfulmenstruationisoneofthemostcommongynecologic
symptoms.Approximately75%ofwomenexperiencedysmenorrhealand
approximately5%ofwomenofreproductiveageareincapacitatedfor13days
eachmonthbecauseofdysmenorrhea.
Forclinicalpurposesdysmenorrheaisoftenclassifiedintotwobroadcategories:
primaryandsecondary.Primarydysmenorrheaisthepresenceofpainful
menstruationintheabsenceofdemonstratablediseasewhilesecondary
dysmenorrheaisduetoanorganicetiology.Itisoftendifficulttodifferentiate
betweenprimaryandsecondarydiseasebasedonphysicalexamandhistory
alone.Trialsofempiricdrugtherapyanddiagnosticlaparoscopyareoftenneeded
todiscoverthecause.Inprimarydysmenorrheathepaincharacteristicallybegins
withtheonsetofmenstruationandlastsfor12to72hours.Primarydysmenorrhea
isusuallyintheabsenceofovulatorycycles.Itusuallybeginswithin6monthsto1
yearfromtheonsetofmenarche.Thepainisconfinedtothelowerabdomenandis
mostintenseinthemidline.Itisoftendescribedascrampyandisintermittent.
Somewomenmayhaveassociatedbackandthighpain.Theabdominalpainmay
beassociatedwithnausea,diarrhea,fatigue,headacheandageneralsenseof
malaise.Thepainisusuallymostsevereonthefirstdayofmenstruationand
graduallydiminishes.
Prostaglandinsplayanimportantroleindysmenorrhea.PGF2alphaandPGE2are
releasedfromtheendometriumandcausedysmenorrheabyinducingsmooth
musclecontraction.Prostaglandininduceduterinecontractions.Commoncauses
includeendometriosis,uterineleiomyomatasandintrauterinecontraceptive
devices.Mostwomenhavedysmenorrheathatismildandsubsideswithinseveral
daysoftheonsetofmenses.However,somewomenexperiencesymptomsthat
aresevereenoughtointerferewithdailyactivityandrequiremedicalevaluation
andtherapy.
Causesofsecondarydysmenorrhea:
Peritoneum:EndometriosisAllenMastersSyndromePelviccongestion
syndrome
Ovary:Ovariancystsortumors
Tubes:PID(acuteandchronic)
Uterus:AdenomyosisUterinemyomasUterinepolypsIntrauterineadhesions
(Asherman'ssyndrome)Congenitalmalformations(bicornuateandseptate
uterus)IUD
Cervix:Stenosisorocclusion
Vagina:ImperforatehymenTransversevaginalseptum
Estimatesofprevalencevarywidely.Dysmenorrheaseemstooccurin75%of
women.Pathologyofdysmenorrheacentersaroundprostaglandinproductionand
releasebytheendometrium.Treatmentincludeshormonaltherapy,surgical
treatment,prostaglandininhibitors,calciumblockersandneuralstimulation.
Laparoscopyisessentialforwomenwithprogressivemenstrualsymptomsthatare
uncontrolledwithOCPsandprostaglandininhibitors.

1. BarbieriRL,RyanKJ.Themenstralcycle.In:RyanKJ,BerkowitzRS,
BarbieriRL,DunaifA,eds.Kistner'sgynecologyandwomen'shealth.7thed.
St.Louis,Missouri:Mosby,1999:53
2. MaxsonWS,RosenwaksZ.Dysmenorrhea,premenstrualsyndrome,and
othermenstrualdisorders.In:CopelandLJ,ed.Textbookofgynecology.
2nded.Philadelphia,Pennsylvania:WBSaunders,2000:515

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