Dysmenorrhea

Dysmenorrhea refers to pain associated with menstruation. It is a common gynecologic complaint characterized by cramping in the lower abdomen, often accompanied by back pain, nausea, vomiting, diarrhea, or headaches during or just before menses. The condition is broadly categorized as primary or secondary.

Primary dysmenorrhea occurs in the absence of identifiable pelvic pathology and is most common in adolescents and young adults. It is thought to result from increased production of prostaglandins in the endometrium, which causes uterine contractions and reduced blood flow, leading to cramps and associated symptoms. Pain typically begins with or shortly after the onset of menses and lasts 1–3 days. Secondary dysmenorrhea is caused by an underlying condition such as endometriosis, uterine fibroids (fibroids or adenomyosis), pelvic inflammatory disease, or an intrauterine device. Pain may begin later in life and can be associated with abnormal bleeding, dyspareunia, or persistent symptoms despite usual therapy.

Diagnosis is usually clinical, based on history and physical examination. Red flags or atypical features (such as severe constant pain, fever, unusual vaginal bleeding, or symptoms starting after age 25) may prompt further evaluation with pelvic imaging or referral. Tests are not routinely needed for uncomplicated primary dysmenorrhea.

Management includes pharmacologic and nonpharmacologic options. First-line treatments are nonsteroidal anti-inflammatory drugs (for example ibuprofen or naproxen) taken at the onset of menses or just before. Hormonal contraception or other progestin therapies can reduce symptoms by suppressing ovulation and endometrial buildup. Nonpharmacologic measures such as heating pads, regular exercise, adequate sleep, and stress management can help. In secondary dysmenorrhea, treatment targets the underlying condition. Prognosis is generally favorable for primary dysmenorrhea, which often improves with age or after childbirth; secondary dysmenorrhea depends on the associated condition.