Information
Editors
Dysmenorrhoea
Essentials
- In primary dysmenorrhoea there are no abnormalities found during a gynaecological examination and there is no need for laboratory investigations.
- In secondary dysmenorrhoea, a gynaecological disease behind the condition should be sought for.
Epidemiology
- Up to 95% of women have occasional dysmenorrhoea.
- 5-15% complain of severe dysmenorrhoea.
Symptoms
- Lower abdominal pain 100%
- Nausea, vomiting 90%
- Tiredness 80%
- Lower back pain 60%
- Dizziness 60%
- Diarrhoea 60%
- Headache 40%
Primary dysmenorrhoea
Symptoms
- Cramping lower abdominal pains emerge with the onset of menstrual bleeding and radiate to the back and thighs.
- Pain lasts for about 24-48 hours.
- Pain is associated with the ovulatory cycle.
- The problem first emerges 6-12 months after menarche.
Aetiology
- Pain is caused by prostaglandins secreted by the uterine mucosa.
- The production of prostaglandins increases after ovulation.
- Prostaglandins cause uterine cramps and decreased blood flow leading to ischaemic uterine pain.
- Prostaglandins released into the circulation cause the systemic symptoms.
Diagnosis
- Usually obvious on the basis of history.
- No abnormalities found during a gynaecological examination.
- No need for laboratory investigations.
Treatment
- In mild cases, an explanation of the reasons behind the symptoms is sufficient.
- Nonsteroidal anti-inflammatory agents are effective Nonsteroidal Anti-Inflammatory Drugs for Primary Dysmenorrhoea.
- They inhibit the action of the cyclo-oxygenase enzyme thus blocking prostaglandin synthesis.
- Medication should be taken immediately at symptom onset or rather just before symptoms.
- The duration of medication is 24-48 hours.
- Provide pain relief in 80-90% of cases.
- Reduce the contractility of the uterus.
- Reduce the amount of blood loss by 20-30%.
- Combined oral contraceptives. Remember contraindications.
- Prevent ovulation and associated pain Combined Oral Contraceptive Pill for Primary Dysmenorrhoea.
- Make the endometrium thinner and reduce the production of prostaglandins.
- Reduce menstrual bleeding.
- May be prescribed even if contraception is not needed.
- May be combined with analgesics.
- May be used in longer cycles (2-3 strips without a pause).
- Progestogen-only pills ("mini pills")
- Good alternative if combined oral contraceptives are not suitable
- May cause spotting or amenorrhoea.
- Partly prevent ovulation.
- Make the endometrium thinner and reduce the production of prostaglandins.
- Hormone-releasing intra-uterine devices
- Make the endometrium thinner and reduce the production of prostaglandins.
- Reduce menstrual bleeding.
- Provide pain relief.
- An ordinary intra-uterine device will worsen dysmenorrhoea.
- Other treatment modes
Secondary dysmenorrhoea
Symptoms
- Previously painless menstruation becomes painful.
- Pain emerges before menstruation commences.
- Pain lasts for the entire duration of menstrual bleeding.
- Maximum prevalence at the age of 30-40 years
- Condition attributable to a gynaecological condition
- Pain also partially attributable to prostaglandins
References
- Dmitrovic R, Kunselman AR, Legro RS. Continuous compared with cyclic oral contraceptives for the treatment of primary dysmenorrhea: a randomized controlled trial. Obstet Gynecol 2012;119(6):1143-50. [PubMed]
- Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015;21(6):762-78. [PubMed]
- Zahradnik HP, Hanjalic-Beck A, Groth K. Nonsteroidal anti-inflammatory drugs and hormonal contraceptives for pain relief from dysmenorrhea: a review. Contraception 2010;81(3):185-96. [PubMed]
- Ferries-Rowe E, Corey E, Archer JS. Primary Dysmenorrhea: Diagnosis and Therapy. Obstet Gynecol 2020;136(5):1047-1058. [PubMed]