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Dysmenorrhea is a topic covered in the 5-Minute Clinical Consult.

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  • 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
  • Secondary dysmenorrhea: often more severe, results from specific pelvic pathology; 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 absenteeism, 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.
  • Up to 42% lose days of school/work monthly due to dysmenorrhea.
  • Up to 20% reported impairment in daily activities.

Etiology and Pathophysiology

  • Primary: Elevated prostaglandin (PGF2α) production through indirect hormonal control (stimulation of production by estrogen) 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
  • Secondary
    • Endometriosis (most common cause)
    • Congenital abnormalities of uterine/vaginal anatomy
    • Cervical stenosis
    • Pelvic inflammatory disease
    • Adenomyosis
    • Ovarian cysts
    • Pelvic tumors, especially leiomyomata (fibroids) and uterine polyps

Not well studied

Risk Factors

  • Primary (1)
    • Cigarette smoking
    • Alcohol use
    • Early menarche (age <12 years)
    • Age <30 years
    • Irregular/heavy menstrual flow
    • Nonuse of oral contraceptives
    • Sexual abuse
    • Psychological symptoms (depression, anxiety, increased stress, etc.)
    • Nulliparity
  • Secondary
    • Pelvic infection
    • Use of intrauterine device (IUD)
    • Structural pelvic malformations
    • Family history of endometriosis in first-degree relative

General Prevention

  • Primary: Choose a diet low in animal fats.
  • Secondary: Reduce risk of sexually transmitted infections (STIs).

Pediatric Considerations
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
  • Endometriosis

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Stephens, Mark B., et al., editors. "Dysmenorrhea." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea.
Dysmenorrhea. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea. Accessed April 19, 2019.
Dysmenorrhea. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116196/all/Dysmenorrhea
Dysmenorrhea [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. 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 - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, 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 -