Primary dysmenorrhea in adult women: Clinical features and diagnosis
- Roger P Smith, MD
Roger P Smith, MD
- Assistant Dean for Graduate Medical Education
- Professor of Clinical Biologic Sciences
- Charles E. Schmidt College of Medicine, Florida Atlantic University
- Andrew M Kaunitz, MD
Andrew M Kaunitz, MD
- Professor and Associate Chairman
- Department of Obstetrics and Gynecology
- University of Florida College of Medicine-Jacksonville
Dysmenorrhea, or painful menstruation, is a common problem experienced by women in their reproductive years. When severe, it interferes with the performance of daily activities, often leading to absenteeism from school, work, and other responsibilities.
DEFINITIONS OF PRIMARY AND SECONDARY DYSMENORRHEA
For clinical purposes, dysmenorrhea is divided into two broad categories, primary and secondary:
●Primary dysmenorrhea refers to the presence of recurrent, crampy, lower abdominal pain that occurs during menses in the absence of demonstrable disease that could account for these symptoms.
●Secondary dysmenorrhea has the same clinical features, but occurs in women with a disorder that could account for their symptoms, such as endometriosis, adenomyosis, or uterine fibroids.
Prevalence — In surveys, 50 to 90 percent of reproductive-aged women worldwide describe experiencing painful menstrual periods [1-10]. The majority of these women are young and have primary dysmenorrhea. The prevalence of primary dysmenorrhea decreases with advancing age .
- Campbell MA, McGrath PJ. Use of medication by adolescents for the management of menstrual discomfort. Arch Pediatr Adolesc Med 1997; 151:905.
- Wilson CA, Keye WR Jr. A survey of adolescent dysmenorrhea and premenstrual symptom frequency. A model program for prevention, detection, and treatment. J Adolesc Health Care 1989; 10:317.
- Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics 1981; 68:661.
- Johnson J. Level of knowledge among adolescent girls regarding effective treatment for dysmenorrhea. J Adolesc Health Care 1988; 9:398.
- Burnett MA, Antao V, Black A, et al. Prevalence of primary dysmenorrhea in Canada. J Obstet Gynaecol Can 2005; 27:765.
- Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982; 144:655.
- Ortiz MI. Primary dysmenorrhea among Mexican university students: prevalence, impact and treatment. Eur J Obstet Gynecol Reprod Biol 2010; 152:73.
- Ortiz MI, Rangel-Flores E, Carrillo-Alarcón LC, Veras-Godoy HA. Prevalence and impact of primary dysmenorrhea among Mexican high school students. Int J Gynaecol Obstet 2009; 107:240.
- Polat A, Celik H, Gurates B, et al. Prevalence of primary dysmenorrhea in young adult female university students. Arch Gynecol Obstet 2009; 279:527.
- Hillen TI, Grbavac SL, Johnston PJ, et al. Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health 1999; 25:40.
- Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990; 97:588.
- Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006; 332:749.
- Widholm O, Kantero RL. A statistical analysis of the menstrual patterns of 8,000 Finnish girls and their mothers. Acta Obstet Gynecol Scand Suppl 1971; 14:Suppl 14:1.
- Ylikorkala O, Dawood MY. New concepts in dysmenorrhea. Am J Obstet Gynecol 1978; 130:833.
- Dawood MY. Primary dysmenorrhea: advances in pathogenesis and management. Obstet Gynecol 2006; 108:428.
- Chan WY, Dawood MY, Fuchs F. Relief of dysmenorrhea with the prostaglandin synthetase inhibitor ibuprofen: effect on prostaglandin levels in menstrual fluid. Am J Obstet Gynecol 1979; 135:102.
- Altunyurt S, Göl M, Altunyurt S, et al. Primary dysmenorrhea and uterine blood flow: a color Doppler study. J Reprod Med 2005; 50:251.
- Dmitrović R. Transvaginal color Doppler study of uterine blood flow in primary dysmenorrhea. Acta Obstet Gynecol Scand 2000; 79:1112.
- Smith RP. The dynamics of nonsteroidal anti-inflammatory therapy for primary dysmenorrhea. Obstet Gynecol 1987; 70:785.
- Hertweck SP. Dysfunctional uterine bleeding. Obstet Gynecol Clin North Am 1992; 19:129.
- Borah T, Das A, Panda S, Singh S. A case of unilateral dysmenorrhea. J Hum Reprod Sci 2010; 3:158.
- Prouty M. Headache and stomach ache: significant symptoms of ulcer in childhood. Review of 216 cases of peptic ulcer. Wis Med J 1966; 65:197.
- Chan WY, Dawood MY. Prostaglandin levels in menstrual fluid of nondysmenorrheic and of dysmenorrheic subjects with and without oral contraceptive or ibuprofen therapy. Adv Prostaglandin Thromboxane Res 1980; 8:1443.
- Forslin L, Falk V, Danielsson D. Changes in the incidence of acute gonococcal and nongonococcal salpingitis. A five-year study from an urban area of central Sweden. Br J Vener Dis 1978; 54:247.
- Westrom, L, Mardh PA. Epidemiology, etiology, and prognosis of acute salpingitis: A study of 1,457 laparoscopically verified cases. In: Nongonococcal Urethritis and Related Diseases, Hobson D, Holmes KK (Eds), Am Soc Microbiol, Washington DC 1977. p.84.
- Westrom L, Mardh PA. Epidemiology, etiology, and prognosis of acute salpingitis: A study of 1,457 laparoscopically verified cases. In: Nongonococcal Urethritis and Related Diseases, Hobson D, Holmes KK (Eds), Am Soc Microbiol, Washington, DC 1977. p.84.
- Korn AP, Hessol NA, Padian NS, et al. Risk factors for plasma cell endometritis among women with cervical Neisseria gonorrhoeae, cervical Chlamydia trachomatis, or bacterial vaginosis. Am J Obstet Gynecol 1998; 178:987.
- Jacobson L, Weström L. Objectivized diagnosis of acute pelvic inflammatory disease. Diagnostic and prognostic value of routine laparoscopy. Am J Obstet Gynecol 1969; 105:1088.
- Wright KN, Laufer MR. Leiomyomas in adolescents. Fertil Steril 2011; 95:2434.e15.
- Lippman SA, Warner M, Samuels S, et al. Uterine fibroids and gynecologic pain symptoms in a population-based study. Fertil Steril 2003; 80:1488.
- Dogan E, Gode F, Saatli B, Seçil M. Juvenile cystic adenomyosis mimicking uterine malformation: a case report. Arch Gynecol Obstet 2008; 278:593.
- Ho ML, Ratts V, Merritt D. Adenomyotic cyst in an adolescent girl. J Pediatr Adolesc Gynecol 2009; 22:e33.
- Tamura M, Fukaya T, Takaya R, et al. Juvenile adenomyotic cyst of the corpus uteri with dysmenorrhea. Tohoku J Exp Med 1996; 178:339.
- Acién P, Bataller A, Fernández F, et al. New cases of accessory and cavitated uterine masses (ACUM): a significant cause of severe dysmenorrhea and recurrent pelvic pain in young women. Hum Reprod 2012; 27:683.
- Barbieri RL, Propst AM. Physical examination findings in women with endometriosis: uterosacral ligament abnormalities, lateral cervical displacement and cervical stenosis. J Gynecol Tech 1999; 5:157.
- Propst AM, Storti K, Barbieri RL. Lateral cervical displacement is associated with endometriosis. Fertil Steril 1998; 70:568.
- Barbieri RL, Callery M, Perez SE. Directionality of menstrual flow: cervical os diameter as a determinant of retrograde menstruation. Fertil Steril 1992; 57:727.
- DEFINITIONS OF PRIMARY AND SECONDARY DYSMENORRHEA
- PRIMARY DYSMENORRHEA
- Risk factors
- Clinical features
- - Presentation
- - Physical findings
- - Laboratory and imaging findings
- - Natural history
- Diagnostic evaluation
- - Exclusion of secondary dysmenorrhea
- Physical examination
- Laboratory testing
- Differential diagnosis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS