Menstruasjonssmerter

Menstruasjonssmerter, or dysmenorrhea, refer to pelvic pain that occurs in association with the menstrual cycle. The condition is distinguished into primary and secondary dysmenorrhea. Primary dysmenorrhea arises without an identifiable pelvic pathology and is thought to be caused by increased prostaglandin production in the endometrium, which leads to uterine hypercontractility and reduced uterine blood flow. Secondary dysmenorrhea results from underlying gynecological conditions such as endometriosis, adenomyosis, uterine fibroids, pelvic inflammatory disease, or congenital anomalies.

Typical symptoms include cramp‑like pain in the lower abdomen that may radiate to the lower back or thighs, nausea, headache, and dizziness. The pain often begins a day or two before menstruation starts and can last from 24 to 72 hours. In secondary cases, pain may begin earlier in the cycle and be accompanied by abnormal bleeding, dyspareunia, or infertility.

Diagnosis is primarily clinical, based on a detailed history and symptom diary. Imaging (ultrasound, MRI) and laparoscopy may be required for suspected secondary causes. A gynecological examination can rule out other causes such as ovarian cysts or pelvic masses.

Treatment of primary dysmenorrhea focuses on non‑steroidal anti‑inflammatory drugs (NSAIDs), hormonal contraceptives, or combined oral contraceptives that suppress ovulation. Heat therapy and physical activity have also shown benefit. For secondary dysmenorrhea, management targets the underlying pathology: hysterectomy, hormone therapy, or surgical excision of endometriotic lesions.

Preventive measures include maintaining a healthy weight, avoiding smoking, and ensuring adequate calcium and vitamin D intake. Regular exercise and balanced nutrition may reduce flare‑ups. When pain is severe, persistent, or progressive, prompt referral to a gynecologist is advised to exclude serious pathology.