Primary Dysmenorrhea: Assessment and Treatment

Abstract

Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic pathology. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility which result in uterine muscle ischemia, hypoxia and subsequently pain. It is the most common gynecological pathology in women in their reproductive years. It is one of the most frequent causes of pelvic pain, however it is underdiagnosed, undertreated, and even undervalued by women themselves who accept it as part of the menstrual cycle. It has major implications for quality of life such as limitation of daily activities and psychological stress, being one of the main causes of school and work absenteeism. Its diagnosis is essentially clinical, based on clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. Treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of non-steroidal anti-inflammatory drugs (NSAIDs) and in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.