Primary Dysmenorrhea: Assessment and Treatment.

Inês Guimarães,Ana Margarida Póvoa

doi:10.1055/s-0040-1712131

Abstract

Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and 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 the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of nonsteroidal 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.

Highlights

Primary dysmenorrhea is defined as colic pain in the suprapubic region with irradiation to the lumbar and thighs that occurs before or during menstruation in the absence of pelvic illness.[1,2,3,4]
The association between multiparity and decreased risk of dysmenorrhea can be explained by several assumptions such as: lower release of prostaglandins by the endometrium after term delivery, neuronal degeneration that occurs in the uterus after a term delivery, and decreased uterine norepinephrine in the third trimester of pregnancy.[20]
Nitric oxide, nitroglycerine and calcium channel blockers are being investigated as potential drugs for the treatment of dysmenorrhea, but they are not yet used for it.[23]

Summary

Introduction

Primary dysmenorrhea is defined as colic pain in the suprapubic region with irradiation to the lumbar and thighs that occurs before or during menstruation in the absence of pelvic illness.[1,2,3,4] Its first manifestation usually appears 6 months after menarche because it occurs only during ovulatory cycles. Non-modifiable risk factors include: family history of dysmenorrhea, age under 20 years (symptoms are more pronounced during adolescence), menarche before age 12 (due to early establishment of ovulatory cycles), menstrual flow lasting longer than 7 days and nuliparity.[1,2,7,14,15,19] The association between multiparity and decreased risk of dysmenorrhea can be explained by several assumptions such as: lower release of prostaglandins by the endometrium after term delivery, neuronal degeneration that occurs in the uterus after a term delivery, and decreased uterine norepinephrine in the third trimester of pregnancy.[20] Behavioral risk factors include: body mass index (BMI) < 20 or > 30, low intake of omega 3 (fish), smoking (nicotine induces vasoconstriction), caffeine consumption ( induces vasoconstriction), and psychosocial symptoms such as depression and anxiety. Because they cause serious adverse effects, they are no longer used for the treatment of primary dysmenorrhea.[3,8,15,23,24]

Hormonal Contraceptives

Findings

Conclusion