Dysmenorrhea

Affecting over 50% of menstruating women, dysmenorrhea results in absenteeism and economic loss. In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology. In secondary dysmenorrhea gross pelvic pathology in present. With primary dysmenorrhea, the pain is suprapubic, spasmodic, lasts for 48–72 h and is most severe during the first or second day of menstruation. Characteristically, dysmenorrhea starts at or shortly after menarche. The pathophysiology in primary dysmenorrhea is due to increased and/or abnormal uterine activity because of the excessive production and release of uterine prostaglandins. Treatment with many non-steroidal anti-inflammatory drugs (NSAIDs) that are prostaglandin synthetase inhibitors will produce relief from dysmenorrhea and a concomitant decrease in menstrual fluid prostaglandins. For those desiring oral contraception or who cannot use NSAIDs, the oral contraceptive pill will relieve dysmenorrhea by suppressing endometrial growth, thus resulting in a decrease in the menstrual flow as well as in menstrual fluid prostaglandins. Laparoscopy is needed if a pelvic abnormality is detected on examination or if medical treatment for up to 6 months is unsuccessful.In secondary dysmenorrhea, relief is obtained when the pelvic pathology is treated. Dysmenorrhea and menorrhagia due to intrauterine contraceptive devices are controlled with NSAIDs.