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High-Yield Facts

  • The pain of dysmenorrhea may be experienced in the pelvis, lower back, or anterior thighs.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for dysmenorrhea.

  • In a normal menstrual cycle there is an average of 5 to 80 mL of blood loss.

  • Abnormal uterine bleeding (AUB) 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 AUB is a negative pelvic examination.


Definition and Epidemiology

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) (Table 101-1).1 The term primary dysmenorrhea refers to pain with menses in the absence of pelvic pathology and typically 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 101-1Classification of Dysmenorrhea

The prevalence of primary dysmenorrhea is estimated to be 43% to 93% with 50% to 70% of adolescent women suffering from this debilitating condition.47 According to one study, only 14% of US adolescents, aged 12 to 17 years with dysmenorrhea, sought help from a physician. Self-treatment for dysmenorrhea is common among adolescent girls and young women, with 30% to 60% of girls report self-medicating with over-the-counter preparations.8

Dysmenorrhea has significant impact for both the individual and society. Approximately 38% of adolescents and 51% of young women describe severe symptoms, causing regular absenteeism from school and work respectively. This symptom burden, which interferes with work several days each cycle, has been estimated to account for 600 million lost working hours and 2 billion dollars in lost productivity annually in the United States.410


The cause of primary dysmenorrhea is unclear; however, the condition is associated with prostaglandin F2 release in the endometrium during menstruation. Sloughing endometrial cells release prostaglandins, causing myometrial contraction and vasoconstriction, which results in pain and cramping. The involvement of vasopressin is postulated to be increased in ...

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