Definition and Classification
Dysmenorrhea is categorized into two distinct types 3, 4, 5:
- Primary dysmenorrhea: Menstrual pain occurring in the absence of identifiable pelvic pathology, representing the most common form in women of reproductive age 2, 3, 4
- Secondary dysmenorrhea: Painful menstruation caused by underlying pelvic pathology or a recognized medical condition, with endometriosis being the leading cause in adolescents and young women 4, 5
Clinical Significance
Dysmenorrhea affects between 45-95% of menstruating women and represents one of the most common gynecological conditions worldwide. 2
The condition has substantial impact on multiple domains 2, 6:
- Quality of life: Women with severe primary dysmenorrhea experience significantly reduced quality of life scores (54% vs 80-81% in controls) during menstruation 6
- Daily functioning: The pain interferes with daily activities and can be debilitating for several days each month 2, 3
- Long-term pain sensitivity: Women with dysmenorrhea demonstrate enhanced pain sensitivity even during pain-free phases of the menstrual cycle, which may increase susceptibility to chronic pain conditions like fibromyalgia later in life 2
Pathophysiology
The underlying mechanism involves the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins 3. These elevated prostaglandins cause uterine contractions that restrict blood flow and generate anaerobic metabolites that stimulate pain receptors 3.
Key Distinguishing Features
Primary dysmenorrhea does not progressively worsen over years and pain is confined to the menstrual period, whereas secondary dysmenorrhea (particularly from endometriosis) presents with progressive worsening of pain over time, pain extending beyond menstruation, and is frequently associated with infertility. 7