Pathogenesis and Management Guideline of Dysmenorrhea

Dysmenorrhea presents as painful periods that start two to three years after menarche. The pain usually begins when the bleeding starts and lasts for 32-48 hours. The cause of menstrual cramps and associated symptoms in primary dysmenorrhea is related to prostaglandin production. In secondary dysmenorrhea, there is documented pelvic pathology that causes the painful menstrual cramps, and treatment is cause related. Risk factors for dysmenorrhea include nulliparity, heavy menstrual flow, smoking, and depression. Empiric therapy can be initiated based on a typical history of painful menses and a negative physical examination Nonsteroidal anti-inflammatory drugs are the initial therapy of choice in patients with presumptive primary dysmenorrhea. Oral contraceptives also may be considered. If pain relief is insufficient, prolonged-cycle oral contraceptives or intravaginal use of oral contraceptive pills can be considered. If dysmenorrheal remains uncontrolled with any of these approaches, pelvic ultrasonography should be performed and referral for laparoscopy should be considered to rule out secondary causes of dysmenorrhea. the use of danazol or leuprolide may be considered and, rarely, hysterectomy. The effectiveness of surgical interruption of the pelvic nerve pathways has not been established.