Dysmenorrhea%20-%20primary Signs and Symptoms

• Primary dysmenorrhea is painful menstruation without demonstrable pelvic pathology

• Intermittent painful spasms, crampy labor-like pain localized over the lower abdomen and the suprapubic area which may radiate to the lower back or inner thighs occurring during and occasionally starting prior to menstruation
  • Pain may also be described as a dull ache or as stabbing pain
• Accompanying symptoms: Nausea, vomiting, diarrhea, constipation, abdominal bloating, changes in appetite, headaches, lightheadedness, fatigue, fever, muscle cramps, body and joint pains, tender breasts, nervousness, anxiety, irritability, depression, lethargy, fainting, increased urination and poor sleep quality
• A study showed the prevalence of dysmenorrhea to be 16-91% in reproductive-aged women with severe pain occurring in 2-29% 
  • Risk of dysmenorrhea is increased with stress and positive family history of dysmenorrhea; smoking aggravates it
  • It improves with patient’s increased age, parity, and oral contraceptive use

Primary Dysmenorrhea

• Symptoms typically start between 6 months-3 years after menarche when ovulatory cycles are established
• Patient has symptoms as described above
  • Evidence suggests that symptoms of primary dysmenorrhea are caused by prostaglandins PGF_2α and PGE₂ that are released from the endometrium at the time of menstruation which cause myometrial hypercontractility and decreased blood flow likely causing pain through ischemia of uterine muscle
• Symptoms characteristically occur 1-2 days before or within 1-4 hours after the onset of menstruation and may last for 12-72 hours
  • Symptoms tend to be the most severe on the first 1-2 days of menstruation when prostaglandin levels are the highest and diminish gradually

Secondary Dysmenorrhea

• Caused by an underlying pelvic pathology and is frequent in older women after having pain-free menstruation 
• Signs and symptoms that may indicate secondary dysmenorrhea:
  • Dysmenorrhea occurring during the first 1-2 cycles after menarche
    • Consider congenital outflow tract obstruction
  • Dysmenorrhea that occurs after the age of 20 years
  • Late onset of dysmenorrhea after a history of previous menstrual cycles without pain
    • Consider ectopic or threatened spontaneous abortion
  • Pelvic pain occurring at times other than menses or non-midline pelvic pain
  • Signs of secondary dysmenorrhea caused by endometriosis
    • Progressive dysmenorrhea
    • Family history of endometriosis
    • Dyspareunia
    • Infertility
  • Heavy menstrual flow or irregular cycles
    • Consider adenomyosis, fibroids, polyps
  • Urinary, musculoskeletal or gastrointestinal (GI) symptoms
    • Consider non-gynecologic process
  • No significant response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives (OCs), or both