From the Guidelines
Primary dysmenorrhea is caused by excessive production of prostaglandins in the uterus during menstruation, leading to intense uterine contractions, pain, and cramping, as well as other symptoms like nausea, vomiting, headaches, and diarrhea. The increased prostaglandin levels also contribute to other symptoms by increasing uterine contractions and causing vasoconstriction. Hormonal imbalances, particularly elevated levels of vasopressin and leukotrienes, can worsen these symptoms 1. Psychological factors such as stress and anxiety may exacerbate the condition. Primary dysmenorrhea typically begins shortly after menarche (first menstruation) when ovulatory cycles are established, usually within 6-12 months. It's essential to distinguish primary dysmenorrhea from secondary dysmenorrhea, which is menstrual pain caused by underlying pathology such as endometriosis or fibroids.
Key Factors Contributing to Primary Dysmenorrhea
- Excessive production of prostaglandins in the uterus during menstruation
- Hormonal imbalances, particularly elevated levels of vasopressin and leukotrienes
- Psychological factors such as stress and anxiety
- Ovulatory cycles and establishment of regular menstruation
Importance of Accurate Diagnosis
Accurate diagnosis is crucial to differentiate primary dysmenorrhea from secondary dysmenorrhea, which may be caused by underlying conditions such as endometriosis, fibroids, or other structural abnormalities 1. A thorough medical history, physical examination, and diagnostic tests may be necessary to rule out underlying conditions.
Treatment Options
Treatment typically includes NSAIDs like ibuprofen (400-800mg every 6-8 hours) or naproxen (500mg initially, then 250mg every 6-8 hours) to inhibit prostaglandin synthesis, and hormonal contraceptives to prevent ovulation and reduce endometrial growth. Lifestyle modifications, such as stress management, regular exercise, and a balanced diet, may also help alleviate symptoms. It is essential to consult a healthcare provider for proper diagnosis and treatment.
From the Research
Primary Dysmenorrhea Causes
- Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease 2, 3, 4
- It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain 2
- The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs) 3
- The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors 3
- Women with primary dysmenorrhea have increased production of endometrial prostaglandin, resulting in increased uterine tone and stronger, more frequent uterine contractions 4
Key Factors
- Prevalence rates of primary dysmenorrhea are as high as 90 percent 4
- Initial presentation of primary dysmenorrhea typically occurs in adolescence 4
- It is a common cause of absenteeism and reduced quality of life in women 2, 3, 4
- The problem is often underdiagnosed and undertreated 2, 4
Treatment
- Nonsteroidal anti-inflammatory medications are the mainstay of treatment 2, 3, 5, 4, 6
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs which act by blocking prostaglandin production 6
- NSAIDs are an effective treatment for dysmenorrhoea, though women using them need to be aware of the significant risk of adverse effects 6