Secondary Dysmenorrhea

Aka: Secondary Dysmenorrhea, Congestive Dysmenorrhea

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II. Definitions

  1. Secondary Dysmenorrhea
    1. Painful Menses secondary to underlying pelvic organic disorder

III. Epidemiology

  1. Accounts for 10% of Dysmenorrhea cases

IV. History: Findings suggestive of Secondary Dysmenorrhea

  1. Changed Dysmenorrhea character, location or intensity
  2. History of prior Sexually Transmitted Disease
  3. Prior abdominal or pelvic surgery
  4. Pelvic Pain persisting throughout cycle
  5. Infertility
  6. Abnormal Menstrual Bleeding
  7. Endometriosis type Rectal Pain or Dyspareunia
  8. Family History of Endometriosis (in a first degree relative)

V. Symptoms

  1. See Dysmenorrhea
  2. Variable or worsening Chronic Pelvic Pain
  3. Abnormal Uterine Bleeding
  4. Vaginal Discharge
  5. Dyspareunia

VI. Evaluation

  1. See Dysmenorrhea

VII. Causes: Secondary Dysmenorrhea (pelvic pathology)

  1. See Dysmenorrhea
  2. See Chronic Pelvic Pain
  3. Emergent causes
    1. Ectopic Pregnancy
  4. Most common causes
    1. Endometriosis (most common)
      1. Pelvic Pain variable in timing and intensity
      2. Dyspareunia
      3. Infertility
      4. Pain with urination and Bowel Movements
    2. Pelvic Inflammatory Disease (PID)
      1. Abdominal Pain, fever and foul Vaginal Discharge
      2. Dyspareunia
      3. Sexually Transmitted Infection
      4. Post-coital bleeding
  5. Other Common causes
    1. Uterine Myomata (Uterine Fibroids)
      1. More common at older age
      2. Menorrhagia, with prolonged menstrual periods
      3. Constipation
      4. Urinary Outflow Obstruction
    2. Adenomyosis (Endometriosis of Uterus)
      1. More common at older age
      2. Menorrhagia, passing blood clots
      3. Dyspareunia
    3. Interstitial Cystitis
      1. Non-cyclical Suprapubic Pain with urinary tract symptoms
    4. Chronic Pelvic Pain
      1. Non-cyclical Pelvic Pain
  6. Miscellaneous causes
    1. See Chronic Pelvic Pain in Women
    2. Intrauterine Device (IUD)
    3. Ovarian Cysts (transient Ovarian Torsion, ruptured Ovarian Cyst)
    4. Cervical stenosis
      1. Amenorrhea
      2. Infertility
    5. Postsurgical pelvic adhesions
      1. Prior abdominal or genitourinary surgery
      2. Infertility
      3. Small Bowel Obstruction
      4. Worse with movement
      5. Painful Defecation
    6. Endometrial Polyps
      1. Irregular Vaginal Bleeding
    7. Congenital obstructive mulleian malformation
      1. Amenorrhea
      2. Infertility
      3. Miscarriages
    8. Pelvic Mass
      1. Nausea
      2. Bloating
      3. Frequent Urination

VIII. Differential Diagnosis

  1. See Primary Dysmenorrhea
  2. See Chronic Pelvic Pain

IX. Management

  1. See Dysmenorrhea for evaluation and management
  2. Evaluate and treat the underlying cause
  3. Symptomatic treatment as with Primary Dysmenorrhea

X. References

  1. McKenna (2021) Am Fam Physician 104(2): 164-70 [PubMed]

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