Dysmenorrhea- means the menstrual cramps, painful periods. These cramps usually occur just before or during periods. In some cases, this can cause discomfort that is merely annoying, while in other cases menstrual cramps are severe enough to interfere with day today activities for a few days in each month.

Menstrual cramps typically caused by uterine contractions.

Conditions such as adenomyosis, endometriosis, or uterine fibroids can lead to menstrual cramps also. The pain can be reduced by treating the cause. Menstrual cramps that are not caused by another conditions tends to reduce with age and often lessen after giving birth.

There are two categories of dysmenorrhea:

  1. Primary dysmenorrhea
  2. Secondary dysmenorrhea

Primary Dysmenorrhea:

In primary dysmenorrhea there is no pelvic pathology involved. The menstrual cramps or pain are at highest level on first two days of menstrual cycle.

Primary Dysmenorrhea can be caused by increased prostaglandin production by the endometrium in an ovulatory cycle which causes contractions of uterine muscles.

Primary dysmenorrhea starts from 12-24 hours prior to the onset of menses.

The abdominal pain can be accompanied by nausea, diarrhea, fatigue, dizziness, or headache.   

Secondary Dysmenorrhea:

In secondary dysmenorrhea there is involvement of pelvic or uterine pathology.

The causes of secondary dysmenorrhea include:

  • Endometriosis- it is the presence of endometrial tissue outside the uterus.
  • Adenomyosis- it is the benign growth of endometrium into the myometrium.
  • Pelvic infection- An infection of vagina, cervix, uterus, fallopian tubes, ovaries, pelvic peritonitis, tubo-ovarian abscess.
  • Uterine fibroids- It is a tumor (benign) originate from smooth muscle tissue layer (myometrium) of the uterus.  
  • Intrauterine contraceptive devices- It is a small device which sits inside the uterus to prevent conception.
  • Congenital uterine or vaginal anomaly

Common symptoms of dysmenorrhea include:

  • Lower abdominal pain
  • Radiating pain from lower back to the thighs.
  • Pain can be sharp pelvic cramps or deep and dull ache.

Secondary dysmenorrhea commonly occurs after the woman has experienced problem free periods for some time.

  • Pain can be longer than the pain occurs at primary dysmenorrhea.
  • Pain may be unilateral, constant, and continues.

The other symptoms of secondary dysmenorrhea include:

  • Painful intercourse
  • Painful defecation
  • Irregular bleeding that may occur at times other than menstruation cycle.

Assessment and Diagnosis

  • History collection
  • Physical examination

Primary dysmenorrhea-
Cramping pain with menstruation and physical examination is absolutely normal.

Secondary dysmenorrhea-

If the signs and symptoms are findings then further evaluation should do, this usually include:

Blood tests:

  • Complete Blood count (CBC)- R/O evidence of infection.
  • Urine analysis- R/O bladder infection.
  • Cervical culture to exclude sexually transmitted infections/diseases.
  • Electrolyte Sedimentation rate (ESR)- to detect an inflammatory process.

Non-invasive diagnostic procedures:

  • Abdominal ultrasound

Transvaginal ultrasound

Invasive diagnostic procedures:

  • Laparoscopic examination
  • Hysteroscopy and D & C (dilation and curettage)


The treatment options for dysmenorrhea includes:

  • Pain relief – NSAIDs, e.g. Naproxen, Ibuprofen.
  • Low doses of oral contraceptive pills.

Heat application:

  • Heat should be applied to the lower abdomen or back may reduce menstrual cramps.

Life style changes such as

  • daily 30 minutes of physical activity and exercise
  • Weight loss
  • Smoking cessation

Relaxation techniques:

  • Adequate sleep and rest.
  • Avoid unnecessary work load.

Treatment for secondary dysmenorrhea include:

Management of secondary dysmenorrhea is directed at diagnosis and treatment of underlying cause (e.g. endometriosis or PID- pelvic inflammatory disease).