Dysmenorrhea: Contemporary Perspectives

Brittany Bettendorf, Sophie Shay, Frank F. Tu
In: Obstetrical & Gynecological Survey · 2008 · vol. 63(9) , pp. 597–603 · doi:10.1097/ogx.0b013e31817f15ff · PMID:18713479 · W2090832404
article OA: closed CC0 ⤵ 8 in-corpus citations
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This review discusses dysmenorrhea, its risk factors, central and peripheral pain mechanisms, current treatments including NSAIDs and OCPs, and alternative therapies with a focus on multidimensional pain processing.

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Abstract

Dysmenorrhea affects up to 80% of reproductive age women, in many cases causing sufficient pain to dramatically affect social and occupational roles. The prevalence varies across ethnic groups, which in part may reflect varying cultural attitudes toward women and menstruation. Key identified risk factors for dysmenorrhea include age of menarche, body mass, dietary habits, associated uterine bleeding disorders, comorbid pelvic pathology, and psychosocial problems. While much of the focus on the pathogenesis of dysmenorrhea has focused on aberrant inflammatory mediators in the uterine environment, recent studies using experimental quantitative sensory testing suggest central processing of pain is enhanced in many of these women as well, similar to both irritable bowel syndrome and painful bladder syndrome, which are closely related visceral pain disorders. The mainstays of treatment include nonsteroidal antiinflammatories and combined oral contraceptives; although only the former has extensive level I evidence to support its efficacy. Surgical treatments (presacral neurectomy or uterosacral nerve ablation) appear to be beneficial in a subset of women, but are associated with small, but serious, risks of visceral or vascular injury. Complementary and alternative treatments such as vitamin B1 and magnesium supplementation have not been studied as extensively but show some promise as well. In particular, treatments targeting central aberrations in pain processing, as used in chronic pain management, may prove beneficial as a more multidimensional approach to this common malady is accepted in our field. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader should be able to organize their approach to patients with dysmenorrheal along a multidimensional continuum, including not only inflammatory models but also central nervous system-based pain disorder models for understanding these symptoms and prepare alternate approaches for women with dysmenorrheal who either fail or decline traditional therapy.

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Condition tags

dysmenorrheairritable_bowel_syndrome

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License: CC0 · commercial use OK