- Pain associated with menstruation.

Causes and Incidence The cause of primary dysmenorrhea is unknown, but the disorder is thought to be tied to uterine contractions and ischemia mediated by prosta-glandin. The most common cause of secondary dysmenorrhea is endometriosis. Dysmenorrhea is a common gynecologic complaint, occurring in 10% of adolescents and young adults. It declines in severity with age and childbirth.

Disease Process It is thought that increased sensitivity of the myometrium to prostaglandin causes uterine contractions and ischemia of the uterine muscle, resulting in a cramping pain. Secondary dysmenorrhea is tied to an underlying pelvic disorder that produces similar cramping conditions.

Symptoms An aching pain low in the abdomen may radiate to the lower back and legs. The pain begins with menses, peaks after 24 hours, and typically subsides within 2 days. Headache, nausea, diarrhea, and urinary frequency may also be present.

Potential Complications None

Diagnostic Tests With secondary dysmenorrhea, a pelvic examination or laparoscopy or both to rule out underlying disorders.

Treatments

Surgery
Laser ablation of endometriosis; dilatation and curettage (DoC), hysterectomy for underlying disorders; presacral neurectomy for primary dysmenorrhea that is unresponsive to medication.

Drugs
Prostaglandin synthetase inhibitors (e.g., ibuprofen, naproxen sodium) to relieve pain; low-dose oral contraceptives if pain continues.

General
Regular exercise; adequate rest; no tobacco use.

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