Dysmenorrhea

Spasmodic Dysmenorrhea (Primary)

Spasmodic (primary) dysmenorrhea produces sharp, cramping pain that is usually localized to the lower abdomen but can affect the lower back and may extend to the digestive tract. It is associated with strong, frequent uterine contractions and decreased resting tone, which reduce blood flow to the uterine muscle and cause ischemia. It typically appears soon after menarche, is most common in younger women in their twenties, and may improve after childbirth.

Can be the result of prostaglandin imbalance (thromboxane A2, prostacyclin, and leukotrienes) which induce abnormal uterine contractions, similarily to the stimulation of labor. These contractions reduce blood flow, leading to hypoxia (uterine), and pain.

Other causes include relative estrogen excess, pelvic constriction, or pelvic spasm (also associated with either constipation or diarrhea).

Congestive Dysmenorrhea (Secondary)

Congestive (secondary) dysmenorrhea produces a heavy, dragging, dull pain that may radiate to the inner thighs, hips, and back. Pain usually starts before the period begins, may occur with edema, and the menstrual blood is often darker and clotted. It is more common in women over 30 and is caused by an underlying pathology, such as:

• Chronic pelvic sepsis
• Pelvic Inflammatory Disease (PID)
• Endometriosis
• Fibroids
• Adhesions
• Tumor
• Adenomyosis
• Polyps
• IUD

Pain associated with this form of dysmenorrhea is usually short lived (1 or 2 days) each month. It can be caused by deficiency status, with poor blood pooling, poor uterine tone, and poor vascular tone.

Dysmenorrhea presents with cramping pain in the lower abdomen around the time of menstruation. Associated symptoms may include lower back pain, nausea, headache, fatigue, diarrhea, and a feeling of heaviness in the pelvis.

Accompanying menorrhagia suggests a uterine cause, while additional abdominal symptoms point to an extrauterine cause, with any distention or ascites raising suspicion of ovarian neoplasm until proven otherwise. Fever, chills, and discharge suggest infection, and coexisting infertility suggests endometriosis.