- Pelvic pain occurring at/around time of menses; a leading cause of absenteeism for women <30 years old
- Primary dysmenorrhea: pelvic pain without pathologic physical findings; diagnosis of exclusion
- Secondary dysmenorrhea: often more severe, results from specific pelvic pathology; often resistant to typical treatments for dysmenorrhea; severity based on activity impairment:
- Mild: painful, rarely limits daily function, or requires analgesics
- Moderate: daily activity affected, rare absenteeism, requires analgesics
- Severe: daily activity affected, likelihood of absenteeism increased, limited benefit from analgesics
- System affected: reproductive
- Synonym(s): menstrual cramps
- Predominant age
- Primary: onset 6 to 12 months after the start of menarche, teens to early 20s
- Secondary: 20s to 30s
- Predominant sex: women only
- Up to 90% of menstruating females have experienced primary dysmenorrhea (1).
- Up to 42% lose days of school/work monthly due to dysmenorrhea.
- Up to 20% reported impairment in daily activities and/or sleep.
Etiology and Pathophysiology
- Primary: Elevated prostaglandin (PGF2α) production through indirect hormonal control (decrease in progesterone at start of menses leads to increase in prostaglandins) causes nonrhythmic hypercontractility and increased uterine muscle tone with vasoconstriction and resultant uterine ischemia. Ischemia results in hypersensitization of type C pain nerve fibers; intensity of cramps directly proportional to amount of PGF2α released (1)
- Endometriosis (most common cause)
- Congenital abnormalities of uterine/vaginal anatomy
- Cervical stenosis
- Pelvic inflammatory disease
- Ovarian cysts
- Pelvic tumors, especially leiomyomata (fibroids) and uterine polyps
Not well studied
- Primary (1),(2)
- Cigarette smoking
- Alcohol use
- Early menarche (age <12 years)
- Age <30 years
- Family history of dysmenorrhea
- Irregular/heavy menstrual flow
- Nonuse of oral contraceptives
- Sexual abuse/history of sexual assault
- Psychological symptoms (depression, anxiety, increased stress, etc.)
- Pelvic infection
- Use of intrauterine device (IUD) in the few months following insertion
- Structural pelvic malformations
- Family history of endometriosis in first-degree relative
- Primary: regular exercise; early childbirth and higher parity; use of hormonal contraceptives
- Secondary: Reduce risk of sexually transmitted infections (STIs).
Onset with first menses raises probability of genital tract anatomic abnormality (i.e., transverse vaginal septum, imperforate or minimally perforated hymen, uterine anomalies).
Commonly Associated Conditions
- Irregular/heavy menstrual periods
- Longer menstrual cycle length/duration of bleeding
- Decreased quality of life
There's more to see -- the rest of this topic is available only to subscribers.
Domino, Frank J., et al., editors. "Dysmenorrhea." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea.
Dysmenorrhea. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea. Accessed May 31, 2023.
Dysmenorrhea. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea
Dysmenorrhea [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 May 31]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Dysmenorrhea ID - 116196 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -