Dysmenorrhea: Overview and Risk Factors

Dysmenorrhea refers to pain and cramping during menses that interfere with normal functioning. It is the most common gynecologic complaint, affecting at least 50% of menstruating women, and 1% to 2% of women experience severe, incapacitating symptoms.
 
Primary dysmenorrhea (menstrual pain that occurs in the absence of underlying pelvic pathology) is thought to be related to the release of prostaglandins during menstruation, which can cause excessive uterine contractions and subsequent ischemia. The pain is most severe at menses onset and lasts 12 to 72 hours. It is wavelike and cramping in nature and may radiate to the back. Accompanying symptoms may include nausea, vomiting, diarrhea, fatigue, headache, and respiratory difficulties. It typically begins within 2 years of menarche.

Secondary dysmenorrhea is caused by pelvic disease, such as endometriosis, uterine fibroids, pelvic inflammatory disease, pelvic adhesions, and cervical stenosis. The pain of secondary dysmenorrhea usually begins earlier in the menstrual cycle and continues beyond the end of menses. Further symptoms may be present depending on the underlying pathology. It typically begins well after menarche, often as late as the fourth or fifth decade of life.

Risk Factors

The following factors are associated with risk for primary dysmenorrhea. Risk factors for secondary dysmenorrhea depend on the underlying pelvic pathology.

Age. The most intense, disabling symptoms occur during adolescence and typically decrease with age.

Sedentary lifestyle.

Factors that decrease the risk of dysmenorrhea include use of oral contraceptive pills and previous pregnancy.