Primary dysmenorrhea

Defined as painful menstruation in the absence of pelvic pathology. 

It manifests by recurrent, crampy, lower abdominal pain during menstruation. 


Is the most common reason for GYN visits, affecting 50-90% of patients. 


Half of patients describe their pain is moderate to severe.


The process is underestimated because women frequently did not seek medical attention and commonly hold that pain is an expected part of menstruation.


Secondary dysmenorrhea is a reflection of similar clinical features during menstruation, but pain is attributable to pelvic abnormalities such as endometriosis, fibroids, add a no meiosis, and congenital anatomic abnormalities.


 It is often underdiagnosed, inadequately treated, and normalized by patients themselves.


Individuals may except the symptoms as an inevitable response to menstruation.


The process generally begins in adolescence after ambulatory cycles are established. 


Pain in dysmenorrhea arises from release of excessive prostaglandins at the time of endometrial sloughing. 


Higher levels of prostaglandin are found in endometrial tissue and menstrual fluid of women who have dysmenorrhea compared with asymptomatic women.


Elevation of prostaglandin levels at the time of menstruation is thought to cause myometrial hyper contractility, that results in ischemia and hypoxemia of uterine muscle and pain.


Elevated prostaglandin levels also cause nausea and diarrhea that is associated with dysmenorrhea.


About 17% of patients reporting primary dysmenorrhea miss school or work, and more than half limit their activities. 


Dysmenorrhea is the most common cause of short term absence from school and adolescent girls, and about one and eight girls teenage girls report missing school or work as a result of dysmenorrhea.


Dysmenorrhea affects relationships, productivity, functioning along with its contribution to absenteeism.


Diagnosis requires a medical, psychosocial, and gynecologic history including menstrual and sexual history.


Menstrual history includes: age at menarche, duration of bleeding, intervals between menses, menstrual flow evaluation, and history of associated symptoms of pain, nausea, diarrhea, and fatigue, the timing of onset of menses, severity of pain, and effects on daily activities.


Primary dysmenorrhea onset usually begin 6-24 months after menarche.


Pelvic pain is primarily in the midline and is described as cramping in the lower abdomen or suprapubic area. 


Patients may describe menstrual pain that radiates around the abdomen into the lumbar area or along the thigh.


The persistence of unilateral symptoms suggest an anatomical abnormality as the cause of pain rather than primary dysmenorrhea.


Management considers a patient’s contraceptive needs because nonsteroidal anti-inflammatory drugs and hormonal contraceptives are first line agents.


Hormonal contraceptives effective in the management of primary dysmenorrhea include: combined hormonal oral contraceptive pills, vaginal rings, transdermal patches, and long acting reversible contraceptives.


Treatment of primary dysmenorrhea just provide pain and symptom relief.


NSAIDs affectively improve dysmenorrhea by decreasing prostaglandin levels by inhibiting cyclo oxygenase mediated production.


Estrogen-progesterone oral contraceptives inhibit proliferation of the endometrial lining and decrease prostaglandin production within the uterus and have been demonstrated as effective in managing dysmenorrhea.


Progestin only management has also demonstrated efficacy in reducing symptoms of dysmenorrhea.








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