Dysmenorrhea

Pain during the menstrual period is of two types: primary, in which the pelvic organs are normal and secondary, in which pathologic lesions are found on pelvic examination or laparoscopic examination of the pelvic organs. Since the incidence varies between 31-92% of the population it has serious implications for our society. It is important to distinguish dysmenorrhea from the premenstrual tension syndrome. Currently primary dysmenorrhea is thought to be due to increased contractility of the myometrium or decreased uterine blood flow from the excessive contractions of increased sensitization of pain fibers to mechanical and chemical stimuli. These three mechanisms of pain production are due to the release of certain prostaglandins from the endometrium during menses which then go directly into the myometrium producing these effects. Situational or psychological factors may accentuate or decrease the pain. Treatment is with antiprostaglandin drugs. There are several causes of secondary dysmenorrhea both congenital and acquired. Laparoscopy is frequently needed along with D&C to make the diagnosis. After diagnosis is made appropriate treatment can be undertaken to relieve the pain.