Menses

Primary Dysmenorrhea

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Primary Dysmenorrhea

  • Epidemiology
  1. Onset occurs within 6 to 12 months of Menarche (may occur as long as 2 years from Menarche in some women)
  2. Prevalence peaks around age 20 years
  3. Lifetime Prevalence of severe Dysmenorrhea: 50-60%
  4. Women incapacitated for 1-3 days of each cycle: 10%
  • Pathophysiology
  1. Idiopathic with no clear pelvic pathology
    1. Contrast with Secondary Dysmenorrhea in which an underlying organic etiology is identified
  2. Uterine hyperactivity
    1. Increased myometrial resting tone >10 mmHg
    2. Increased contractile myometrial pressure >120 mmHg
    3. Increased frequency of uterine contractions
    4. Dysrhythmia of uterine contractions
  3. Increase in enzyme Prostaglandin Synthetase
  4. Increased prostaglandins result in Vasoconstriction
  5. Uterine Hypoxia (uterine Angina)
  • Symptoms
  • Examination
  1. See Dysmenorrhea
  2. Normal pelvic examination
  • Differential Diagnosis
  • Precautions
  1. Primary Dysmenorrhea is a diagnosis of exclusion
  2. Exclude Secondary Dysmenorrhea causes (at minimum: pregnancy, Urinary Tract Infection and Sexually Transmitted Infection
    1. Older women without prior history of Dysmenorrhea should be assumed to have Secondary Dysmenorrhea until thorough evaluation is completed
    2. In young women, Secondary Dysmenorrhea still accounts for 10% of cases (especially due to Endometriosis)
  • Management