Dysmenorrhea

Between 40 and 60 % of women experience painful menstruation (dysmenorrhea, algomenorrhea), about 40 % of women report some discomfort in the second half of cycle (premenstrual cycle), pain in the middle of the cycle is less common (intermenstrual pain).

90 % of women experience some discomfort at least during one menstrual cycle.

So, dysmenorrhea is a painful menstruation.


 * between 5 and 10 % of women with dysmenorrhea have to visit a doctor and take sick leave;
 * dysmenorrhea is more serious during an ovulatory cycle than during an anovulatory cycle.

Dysmenorrhea can be classified as:


 * primary (functional, spastic) – begins immediately after menarche;
 * secondary (organic) – later, as a sign or as a result of an underlying condition;
 * dysmenorea membranacea – convulsive pain, a uterine mucosa discharges as a mucosal sac.

Primary dysmenorrhea

 * Lower back pain, pain in a lower abdomen, frequently convulsive in the beginning of menstruation;
 * often GIT signs (meteorism, vomiting), breast tenderness, migraine headache, polakisuria;
 * cause – apparently uncoordinated functions of the uterus;
 * increased production of prostaglandins increases contraction of the uterus and therefore the intrauterine pressure increases ;
 * more commonly found in asthenic women with vegetative dystonia and with hypoplasia of internal genital organs;
 * we look for congenital malformations, cervical stenosis, hormonal disorder.

Secondary dysmenorrhea

 * Onset usually after age 30
 * Causes – endometriosis, result of the inflammation of internal genital organs (adhesion, uterus fixated in RVF ), stenosis and scars in uterus or on the cervix, tumors (especially submucosal myoma, cervical polyps).
 * manifests primarily with pain, there are no total signs (algomenorrhea).

Diagnosis

 * anamnesis, gynecological examination, hysterography, laparoscopy, …

Treatment

 * secondary: based on the established cause and with consideration of age;
 * primary: very difficult – NSAID, analgesics, spasmolytics, injection of pelvic plexuses;
 * hormonal therapy – progesterons in second half of the cycle, blockade of ovulation with contraceptives;
 * if there is a cervical stenosis – dilation.

Related Articles

 * Menstruation
 * Ovarian Cycle
 * Premenstrual Syndrome