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[dys- + meno- + -rrhea]
Pain associated with menstruation. It is one of the most frequent gynecological disorders and is classified as primary or secondary. An estimated 50% of menstruating women experience this disorder, and about 10% of these are incapacitated for several days during each menstrual period. This disorder is the greatest single cause of absence from school and work among menstrual-age women. In the U.S. this illness causes the loss of an estimated 140 million work hours each year.
SEE: premenstrual tension syndrome

Primary dysmenorrhea has multiple possible causes, including hormonal imbalances, psychogenic factors, and increased prostaglandin secretion in menstrual flow, which intensifies uterine contractions, resulting in increased uterine hypoxia and pain. Above age 20, dysmenorrhea usually has a secondary cause. Secondary dysmenorrhea may be related to gynecologic disorders such as endometriosis, cervical stenosis, uterine leiomyomas (fibroids), uterine malposition, pelvic inflammatory disease, pelvic tumors, or adenomyosis. Dysmenorrhea may be associated with premenstrual syndrome symptoms such as frequent urination, nausea, vomiting, diarrhea, headache, backache, abdominal bloating, painful breasts, chills, irritability, and depression. Prostaglandins and their metabolites also can cause headache, syncope, and GI disturbances.

Young women experiencing discomfort or pain during menstruation are encouraged to seek medical evaluation to attempt to determine the cause. Dysmenorrheal pain usually begins just before or at the start of menstrual flow and peaks within 24 hr. Pain is described as sharp, intermittent, cramping, radiating to the lower back, thighs, groin, or vulva. Relieving the pain should be the initial concern. Patients are taught to evaluate pain severity using a 1 to 10 scale. Pharmacological therapies include analgesics (aspirin, NSAIDs) for mild to moderate pain. These are most effective if taken 24 to 48 hr before the onset of menses, and are effective because they are anti-inflammatory and inhibit prostaglandin synthesis (by inhibiting the enzyme cyclooxygenase), decreasing the strength and severity of uterine contractions. Opioids or acetaminophen/opioid combinations may be prescribed for severe pain, to be used infrequently (when pain is at its worst). In primary dysmenorrhea, hormonal contraceptives relieve symptoms by suppressing ovulation (dysmenorrhea is associated with ovulatory cycles). Patients who would like to become pregnant should use antiprostaglandins rather than hormonal therapies for their dysmenorrhea.

Support and assistance are offered to help the patient to deal with the problem. Appropriate patient teaching should be provided, including explanations of normal female anatomy and physiology and the pathophysiology of dysmenorrhea. This is esp. important for adolescents and should include determining the patient’s understanding of conception and pregnancy, and provision of information on contraception as appropriate. Application of mild heat to the abdomen may be helpful, but care must be taken in young adolescents because appendicitis may mimic dysmenorrhea. A well-balanced diet and moderate exercise are encouraged. Noninvasive pain relief measures, e.g., relaxation, distraction, and guided imagery, are employed, and the patient may be referred for biofeedback training to control pain and to support and self-help groups. Treatment in secondary dysmenorrhea focuses on identifying and, if possible, correcting the underlying cause. Conservative therapies are tried initially, but in some cases surgical treatment may be required.

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