The diagnosis and treatment of primary dysmenorrhea

Karolina Obuchowska, Aleksandra Obuchowska, Arkadiusz Standyło, Kamila Gorczyca, Justyna Wójcik-Grudzień, Alicja Ozga, Paulina Pawłowska, Martyna Rozenbajgier, Przemysław Żelazny, Joanna Filipczak, Żaneta Kimber-Trojnar, Bożena Leszczyńska‐Gorzelak
In: Journal of Education, Health and Sport · 2022 · vol. 12(9) , pp. 632–638 · doi:10.12775/jehs.2022.12.09.076 · W4295027754
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Primary dysmenorrhea, characterized by pelvic pain due to endometrial prostaglandin overproduction, is common and treatable with hormonal contraception, NSAIDs, or alternative therapies when conventional treatment is contraindicated.

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The paper reviews the diagnosis and treatment of primary dysmenorrhea, a common cause of pelvic pain in adolescent girls and reproductive-age women, defining it as menstrual-cycle–related pelvic pain without a specific underlying cause. It describes a key mechanistic model centered on endometrial overproduction of prostaglandins leading to uterine hypercontractility, ischemia/hypoxia, and pain, and summarizes that hormonal contraception and NSAIDs are effective, while typical histories can support empirical therapy without further testing, with the important caveat that secondary causes must be excluded. It also outlines less common alternatives when conventional options are contraindicated (e.g., heat, TENS, lifestyle changes, dietary supplements, acupuncture/acupressure) and notes that surgical approaches are rare and reserved for severe, treatment-resistant cases. Relevance to endometriosis: the paper discusses dysmenorrhea and explicitly emphasizes excluding secondary causes, within the context of broader gynecologic pelvic-pain differentials that include endometriosis (citing ACOG Committee Opinion No. 760 on dysmenorrhea and endometriosis in adolescents), though the paper’s main focus is primary dysmenorrhea management rather than endometriosis itself.

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Abstract

Primary dysmenorrhea is defined as pain in the pelvic area that occurs for no specific reason during menstrual cycle. Dysmenorrhea occurs in 50% to 90% of adolescent girls and women of reproductive age which makes it one of the most common causes of pelvic pain in women. The mechanism of this condition is overproduction of prostaglandins by the endometrium, causing uterine hypercontractility, thereby leading to uterine muscle ischemia, hypoxia and pain. Dysmenorrhea significantly reduces the quality of women life, often making it impossible to perform daily activities and, in addition, it may cause a mental stress that makes both professional and school life difficult. Despite this, females often consider these symptoms as a normal part of their menstrual cycle, which makes this disease underrated and untreated. Dysmenorrhea can be treated in a various ways such as non-pharmacological, pharmacological and surgical. However, women with a typical history of primary dysmenorrhea can commence empirical therapy without any additional tests. Hormonal contraception and nonsteroidal antiinflammatory drugs have proved to be effective in this treatment. However, if conventional treatment is contraindicated, alternative treatments such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure may be used. Surgical treatment is possible, but it is used rarely and only in severe cases of treatment-resistant dysmenorrhea. However, it should be emphasized how important it is to exclude secondary causes of dysmenorrhea.
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The diagnosis and treatment of primary dysmenorrhea DOI: https://doi.org/10.12775/JEHS.2022.12.09.076Keywords primary dysmenorrhea, dysmenorrhea, menstruationAbstract Primary dysmenorrhea is defined as pain in the pelvic area that occurs for no specific reason during menstrual cycle. Dysmenorrhea occurs in 50% to 90% of adolescent girls and women of reproductive age which makes it one of the most common causes of pelvic pain in women. The mechanism of this condition is overproduction of prostaglandins by the endometrium, causing uterine hypercontractility, thereby leading to uterine muscle ischemia, hypoxia and pain. Dysmenorrhea significantly reduces the quality of women life, often making it impossible to perform daily activities and, in addition, it may cause a mental stress that makes both professional and school life difficult. Despite this, females often consider these symptoms as a normal part of their menstrual cycle, which makes this disease underrated and untreated. Dysmenorrhea can be treated in a various ways such as non-pharmacological, pharmacological and surgical. However, women with a typical history of primary dysmenorrhea can commence empirical therapy without any additional tests. Hormonal contraception and nonsteroidal antiinflammatory drugs have proved to be effective in this treatment. However, if conventional treatment is contraindicated, alternative treatments such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure may be used. Surgical treatment is possible, but it is used rarely and only in severe cases of treatment-resistant dysmenorrhea. However, it should be emphasized how important it is to exclude secondary causes of dysmenorrhea. References Dawood, M Yusoff MD. Primary Dysmenorrhea: Advances in Pathogenesis and Management. Obstetrics & Gynecology: August 2006 - Volume 108 - Issue 2 - p 428-441 doi: 10.1097/01.AOG.0000230214.26638.0c Stella Iacovides, Ingrid Avidon, Fiona C. Baker, What we know about primary dysmenorrhea today: a critical review, Human Reproduction Update, Volume 21, Issue 6, November/December 2015, Pages 762–778, https://doi.org/10.1093/humupd/dmv039 Burnett M, Lemyre M. No. 345-primary dysmenorrhea consensus guideline. J Obstet Gynaecol Can 2017; 39 (07) 585-595 . Doi: 10.1016/j.jogc.2016.12.023 Burnett MA, Antao V, Black A, Feldman K, Grenville A, Lea R, et al. Prevalence of primary dysmenorrhea in Canada. J Obstet Gynaecol Can 2005;27:765–70. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 21 (06) 762-778 . Doi: 10.1093/humupd/dmv039 Guimarães I, Póvoa AM. Primary Dysmenorrhea: Assessment and Treatment. Rev Bras Ginecol Obstet. 2020 Aug;42(8):501-507. English. doi: 10.1055/s-0040-1712131. Epub 2020 Jun 19. PMID: 32559803. Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014 Mar 1;89(5):341-6. PMID: 24695505. Ferries-Rowe, Elizabeth MD, MA; Corey, Elizabeth MD, MPH; Archer, Johanna S. VMD, MD. Primary Dysmenorrhea: Diagnosis and Therapy. Obstetrics & Gynecology: November 2020 - Volume 136 - Issue 5 - p 1047-1058 doi: 10.1097/AOG.0000000000004096 Morrow C, Naumburg EH. Dysmenorrhea. Prim Care 2009; 36 (01) 19-32, vii . Doi: 10.1016/j.pop.2008.10.004 Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999 Aug;60(2):489-96. PMID: 10465224. Ryan SA. The treatment of dysmenorrhea. Pediatr Clin North Am 2017; 64 (02) 331-342 . Doi: 10.1016/j.pcl.2016.11.004 ACOG Committee Opinion No. 760: dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol 2018; 132 (06) e249-e258 . Doi: 10.1097/AOG.0000000000002978 Smith RP, Kaunitz AM. Dysmenorrhea in adult women: treatment [Internet]. 2019 [cited 2019 Mar 10]. Available from: https://www.uptodate.com/contents/dysmenorrhea-in-adult-women-treatment Doty E, Attaran M. Managing primary dysmenorrhea. J Pediatr Adolesc Gynecol 2006; 19 (05) 341-344 . Doi: 10.1016/j.jpag.2006.06.005 Ramirez C, Donnellan N. Pelvic denervation procedures for dysmenorrhea. Curr Opin Obstet Gynecol 2017; 29 (04) 225-230 . Doi: 10.1097/GCO.0000000000000379 French L. Dysmenorrhea. Am Fam Physician 2005; 71 (02) 285-291 Downloads Published How to Cite Issue Section License Copyright (c) 2022 Karolina Obuchowska, Aleksandra Obuchowska, Arkadiusz Standyło, Kamila Gorczyca, Justyna Wójcik-Grudzień, Alicja Ozga-Stachurska, Paulina Pawłowska, Martyna Rozenbajgier, Przemysław Żelazny, Joanna Filipczak, Żaneta Kimber-Trojnar, Bożena Leszczyńska-Gorzelak This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Stats Number of views and downloads: 2196 Number of citations: 0

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