Dysmenore

Dysmenore, often referred to as dysmenorrhea, is the medical term for painful menstrual cramps that occur before or during menstruation. It is commonly divided into primary dysmenorrhea, caused by normal uterine contractions and prostaglandin activity, and secondary dysmenorrhea, due to an underlying pelvic condition such as endometriosis, fibroids, adenomyosis, or pelvic inflammatory disease.

Symptoms include cramping pain in the lower abdomen that may radiate to the back or thighs, along with nausea, vomiting, diarrhea, headaches, dizziness, and fatigue. Symptoms typically begin with or soon after the start of the period and may last one to three days; severity varies widely.

Pathophysiology: Primary dysmenorrhea results from increased prostaglandin production during menses, which causes stronger uterine contractions and reduced blood flow. Secondary dysmenorrhea reflects the pain pattern of the underlying condition and may be progressive with time or age.

Diagnosis: Based on history and exam; pregnancy testing to exclude pregnancy-related pain. Ultrasound or other imaging may be used if pelvic disease is suspected. In persistent or unclear cases, evaluation for conditions such as endometriosis may be warranted.

Treatment: For primary dysmenorrhea, first-line therapies are nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptives to reduce uterine activity and menstrual flow. Nonpharmacologic measures—heat, regular exercise, rest, and relaxation—can help. Secondary dysmenorrhea requires treatment of the underlying condition.

Prognosis and impact: Dysmenore is common among those who menstruate and can affect daily activities. With appropriate management, symptoms often improve with age or after childbirth, though secondary causes may require ongoing care. Seek medical advice if pain is severe, sudden, changes pattern, or is accompanied by abnormal bleeding or fever.