Dysmenorrea

Dysmenorrhea is the medical term for painful menstrual cramps, typically occurring in the lower abdomen or pelvis during menses. Symptoms can include dull or sharp cramps, pressure, backache, nausea, vomiting, headaches, fatigue, and sometimes dizziness. The condition is commonly divided into primary and secondary dysmenorrhea.

Primary dysmenorrhea occurs in individuals who have not had an underlying gynecologic pathology. It usually begins in adolescence, often within the first few years after menarche, and tends to improve with age or after childbirth. The pain is believed to result from the release of prostaglandins during the menstrual cycle, which causes stronger uterine contractions and reduced blood flow.

Secondary dysmenorrhea is due to an identifiable pelvic condition, such as endometriosis, adenomyosis, uterine fibroids, or pelvic inflammatory disease. Secondary dysmenorrhea often starts later in life, may become progressively worse, and may be associated with other symptoms such as abnormal bleeding or infertility.

Evaluation typically involves a thorough history and physical examination. In primary cases, imaging is usually not required. If red flags appear or symptoms suggest a secondary cause, pelvic ultrasound or MRI and consideration of evaluation for endometriosis may be appropriate.

Treatment focuses on symptom relief and addressing underlying causes. For primary dysmenorrhea, NSAIDs (for example, ibuprofen or naproxen) and hormonal contraception are commonly effective. Nonpharmacologic measures include heat therapy, regular exercise, adequate sleep, and smoking cessation. Treating secondary causes often requires targeted therapy by a clinician.