Primary dysmenorrhea is painful menstrual cramping in the absence of pelvic pathology (disease of the pelvis). The pain occurs only in relation to ovulation. The pain involves the uterus and can also radiate to the lower back and thigh area. The painful period can also be accompanied by sweating, tachycardia, headaches, nausea, vomiting, diarrhea, and tremors. Dysmenorrhea is more common in younger women, declining after 30 years of age. The symptoms are induced by the hormone prostaglandin and are mediated within the lining of the uterus (endometrium) that is the primary site of prostaglandin production during menses. The pain is thought to be caused by (secondary to) reduction in blood flow (ischemia), which accompanies the uterine contractions in menstruation. The treatment of primary dysmenorrhea includes prostaglandin inhibitors to reduce uterine contractions and intrauterine pressure. Common medications include fenamates, aspirin, and nonsteroidal anti-inflammatory drugs such as Motrin, Naprosyn, Anaprox, and indomethacin. Other effective treatments include oral contraceptives that inhibit ovulation and suppress prostaglandin production in the lining of the uterus (endometrium). A specialized procedure to cut specific nerves causing the pain (laparoscopic uterosacral nerve ligation) has been used in patients who have not been helped by standard medical therapy. However, this is not a routine practice. Dysmenorrhea has been reported to be increased among mother and sisters of women with painful periods.
Secondary dysmenorrhea is painful menstrual cramping due to pelvic pathology. This may occur at any age after menarche and before menopause and is usually seen in women over 20 years of age. A complete history and physical examination along with diagnostic tests such as laparoscopy, hysteroscopy, ultrasound, and hysterosalpingography (specialized imaging test to examine the uterus and tubes going out from the uterus) may assist in the diagnosis of this condition. Common causes of secondary dysmenorrhea (menstrual pain related to another medical condition) include cervical stenosis (cervical closure/narrowing), endometriosis (abnormal uterine tissue), pelvic infections due to sexually transmitted diseases, adhesions from having prior pelvic surgery, pelvic congestion syndrome, stress, and use of an intrauterine device (IUD). In addition, secondary dysmenorrhea may occur in patients with psychological issues. Many causes of secondary dysmenorrhea require surgical management but some patients may benefit from a referral to a chronic pain management clinic where a multidisciplinary approach to their pain is planned.