Dysmenorrhea: Primary And Secondary

Introduction

• Description: Primary dysmenorrhea is painful menstruation without a clinically identifiable cause. Secondary dysmenorrhea is recurrent menstrual pain resulting from a clinically identifiable cause or abnormality.

• Prevalence: Of all women, 10%–15% are unable to function because of pain; 90% have discomfort with at least one cycle.

• Predominant Age: Late teens to early 30s (primary), prevalence follows the occurrence of underlying conditions for secondary dysmenorrhea. Dysmenorrhea that begins after the age of 25 years is most often secondary.

• Genetics: No genetic pattern, although some suggest a familial pattern.

Etiology and Pathogenesis

• Causes: Primary—increased production of prostaglandin F2α (PGF2α) resulting in increased uterine contractions (dysrhythmic) and markedly elevated intrauterine pressures (up to 400 mm Hg); possible increased sensitivity to PGF2α as well. Secondary—uterine (adenomyosis, cervical stenosis, and cervical lesions), congenital abnormalities (outflow obstructions, uterine anomalies), infection (chronic endometritis), intrauterine contraceptive devices, myomas (generally intracavitary or intramural), polyps; extrauterine (endometriosis [most common], inflammation, and scarring [adhesions]); nongynecologic causes (musculoskeletal, gastrointestinal, urinary); “pelvic congestive syndrome” (debated); psychogenic (rare); tumors (myomas, benign or malignant tumors of ovary, bowel, or bladder).

• Risk Factors: None known.

Signs and Symptoms

• Primary—crampy, midline, lower abdominal pain (often demonstrated by a fist opening and closing)

• Nausea, vomiting, and diarrhea are common.

• Syncope

• Headache

• Secondary—midline lower abdominal or low back pain accompanying menstruation

• Pelvic heaviness or pressure

• Symptoms specifically associated with the underlying condition

Diagnostic Approach