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PäiviHärkki

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

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

Aetiology

Diagnosis

Treatment

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]