- Dysmenorrhea is the most common cause of school/work absenteeism.
- The pain of dysmenorrhea may be experienced in the pelvis, lower back, or anterior thighs.
- Nonsteroidal anti-inflammatory drugs are the first-line treatment for dysmenorrhea.
- In a normal menstrual cycle there is an average of 35 to 80 mL of blood loss.
- Dysfunctional uterine bleeding is a diagnosis of exclusion and involves any disturbance in regularity, frequency, duration, or volume of menstrual flow.
- Up to 20% of adolescents with dysfunctional uterine bleeding will have a coagulopathy.
- The hallmark of dysfunctional uterine bleeding is a negative pelvic examination.
Dysmenorrhea is defined as cyclic menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified by pathophysiology (primary or secondary) or by intensity (mild, moderate, or severe)1 (Table 98–1). The term primary dysmenorrhea refers to pain with menses in the absence of pelvic pathology, and usually begins early in adolescence once the regular ovulatory cycle has been established. Secondary dysmenorrhea is usually associated with underlying pelvic pathology, occurs at any time after menarche, and is most often seen in older women.2,3
Table 98-1. Classification of Dysmenorrhea |Favorite Table|Download (.pdf)
Table 98-1. Classification of Dysmenorrhea
No pelvic pathology
No systemic symptoms
Medication rarely required
Work rarely affected
Uterine fibroids and adenomyosis
Ovarian cyst or tumors
Few systemic symptoms
Pelvic inflammatory disease
Work moderately affected
Intrauterine device use
Gastrointestinal disorders: irritable bowel disease, celiac disease
Malformation of the Mullerian ducts
Poor medication response
Obstruction of menstrual flow: bicornuate or septate uterus, vaginal septum, imperforate hymen
A systematic review of the literature from 1996 to 2001 estimates the prevalence of primary dysmenorrhea to be 43% to 93%; the lowest prevalence is among the younger adolescents and the greatest severity in the older adolescent girls.4–6 According to one study, only 14% of US adolescents aged 12 to 17 years with dysmenorrhea sought help from a physician and 30% to 60% of girls report at least occasionally self-medicating with over-the-counter preparations.7
The societal impact of dysmenorrhea is great. Dysmenorrhea is the most common cause of school and work absenteeism and results in limitations on social, academic, and sporting activities. As per data from various studies, 38% of adolescent girls miss school, 51% of women with primary dysmenorrhea limit their activities, and 17% miss work because of secondary dysmenorrhea.4–8
The cause of primary dysmenorrhea is unclear but is associated with prostaglandin F2 release in the endometrium during menstruation. Sloughing endometrial cells release prostaglandins, causing myometrial contraction and vasoconstriction and resulting in pain and cramping. The involvement of vasopressin is still controversial but is postulated to be increased in menstrual fluids ...