Dysmenorrhea

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: Dysmenorrhoea; menstrual cramps; menorrhalgia; menstrual pain

Classification

The two types of dysmenorrhea are:

• Primary or spasmodic dysmenorrhea
• Secondary or congestive dysmenorrhea

Primary Dysmenorrhea

• Lower abdominal pain that occurs during a menstrual cycle and is not associated with any pelvic pathology
• Usually disappears in women by pregnancy or in late 20's

Secondary Dysmenorrhea

• Lower abdominal pain that occurs during a menstrual cycle and is associated with pathologies inside and outside the uterus
• Usually prevelant over 20's

Pathophysiology

The pathophysiology of primary dysmenorrhea has not been clearly established for a long period of time. But it is believed to be due to increased prostaglandin and eicosanoid production. The increased prostaglandin production leads to increased myometrial contractibility, inturn leading to ischaemia and hypoxia. As compared to proliferative endometrium, secretory endometrium has been linked to raised progesterone levels. The increase in these hormone levels plays a key effect in prostaglandin production and its consequent effects. Some preliminary studies suggest that an increase in vasopressin levels without an increase in oxytocin is believed to cause stronger uterine contractions leading to decrease in the uterine blood supply.

Causes

Primary Dysmenorrhea

• Uterine contractions caused by high prostaglandin concentration, inturn causing shedding of the endometrial lining.

Secondary Dysmenorrhea

• Intramural Causes:
  • Leiomyoma
  • Adenomyosis

• Extrauterine Causes:
  • Endometriosis

• Intrauterine causes:
  • Leiomyomata
  • Polyps
  • IUDs
  • Infection
  • Cervical Stenosis
  • Other cervical lesions

• Other less common causes:
  • Adhesions
  • Ectopic pregnancy
  • Spontaneous abortion
  • Pelvic Inflammatory Disease
  • Pelvic congestion Syndrome
  • Ovarian cysts
  • Allen Masters Syndrome
  • Obstructive malformations of uterine tract
  • Psychogenic
  • Nongynaecological causes

Natural History, Complications and Prognosis

Although dysmenorrhea has a good prognosis, it is associated with frequent abseentism and poor quality of life, daily living & work productivity.

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

• Premenstrual syndrome (PMS)
• Stress and anxiety
• Pelvic inflammatory disease
• Adenomyosis
• History of sexual or physical abuse
• Leiomyoma
• Ovarian cysts
• Endometriosis

References

• Andreoli, Thomas E., Charles C. J. Carpenter, Robert C. Griggs, and Joseph Loscalzo. CECIL Essentials of Medicine, 6th ed. Saunders, 2004. ISBN 0-7216-0147-2
• Chapman-Smith, David A. "The Chiropractic Profession." NCMIC Group Inc., 2000. ISBN 1-892734-02-8
• Hacker, Neville F., J. George Moore, and Joseph C. Gambone. Essentials of Obstetrics and Gynecology, 4th ed. Elsevier Saunders, 2004. ISBN 0-7216-0179-0
• Jun E (2004). "[Effects of SP-6 acupressure on dysmenorrhea, skin temperature of CV2 acupoint and temperature, in the college students]". Taehan Kanho Hakhoe Chi. 34 (7): 1343–50. PMID 15687775.
• Proctor M, Hing W, Johnson T, Murphy P (2006). "Spinal manipulation for primary and secondary dysmenorrhoea". Cochrane Database Syst Rev. 3: CD002119. PMID 16855988. CS1 maint: Multiple names: authors list (link)
• White A (2003). "A review of controlled trials of acupuncture for women's reproductive health care". J Fam Plann Reprod Health Care. 29 (4): 233–6. PMID 14662058.
• Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X

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