Primary dysmenorrhea, which is defi...

Primary dysmenorrhea, which is defined as painful mense in women with normal pelvic anatomy, usually begins during adolescence. It is characterized by way of crampy pelvic pain beginning shortly before or at the charge of menses and lasting undivided to three days. Dysmenorrhea also may be secondary to pelvic organ pathology.

The prevalence of dysmenorrhea is highest in adolescent women with estimates ranging from 20 to 90 percent depending forward the measurement method used. (1-3) About 15 percent of adolescent girls report plain dysmenorrhea, (1,4) and it is the leading cause of intermittent short-term school absenteeism in adolescent girls in the United States. (25) A longitudinal studious mood (6) of a representative cohort of Swedish women rest a prevalence of dysmenorrhea of 90 percent in women 19 years of age and 67 percent in women 24 years of age. Ten percent of the 24-year-olds reported pain that interfered with daily function. most numerous adolescents self-medicate with over-the-counter medicines, and not many consult a physician about dysmenorrhea. (1-3)

Pathogenesis

Dysmenorrhea is idea to be caused by the release of prostaglandins in the menstrual fluid, which causes uterine contractions and pain. Vasopressin also may play a part by pain. increasing uterine contractility and causing ischemic pain as a rise of vasoconstriction. Elevated vasopressin on a levels have been reported in women with primary dysmenorrhea.

The relationship between endometriosis and dysmenorrhea is not clear. Endometriosis may be asymptomatic, or it may be associated with pelvic pain that is not limited to the menstrual period and the cheap anterior pelvis. In one thought (7) of women undergoing elective sterilization, no difference was establish in the prevalence of dysmenorrhea in women with and women without an incidental finding of endometriosis. However, an observational investigation (8) of women undergoing laparoscopy for infertility supported a relationship between dysmenorrhea and the severity of endometriosis.

Risk Factors

Young age and nulliparity are associated with dysmenorrhea. (49) However, single longitudinal study (6) found that age was not a risk factor after controlling for parity and other factors, and that dysmenorrhea improved after childbirth. Heavy menstrual spring is associated with dysmenorrhea. (459) Table 1 lists risk factors for dysmenorrhea.

Behavioral risk factors are of interest because of the potential to intervene. Several observational studies (61011) have ground an association between smoking and dysmenorrhea. In women 14 to 20 years of age, attempts to misspend weight are associated with increased menstrual pain independent of visible form [i]or[/i] frame mass index. (12) However, the evidence of an association between overweight and dysmenorrhea is inconsistent. (4610) Other behaviors so as physical activity and alcohol consumption have not been associated consistently with dysmenorrhea. (1011)

Mental health enigmas are another potentially modifiable risk factor. Depression, anxiety, and disruption of social support networks have been associated with menstrual pain. (13) An association between poor self-rated overall health and dysmenorrhea has been noted, (9) on the contrary socioeconomic status is not associated consistently with dysmenorrhea. (59) Although there has been affect that tubal sterilization may be a risk factor for dysmenorrhea, a cross-sectional application of mind (14) found no difference in menstrual pain in women with and women without tubal sterilization.

Diagnosis

In mostly patients who present with menstrual pain, empiric therapy may be prescribed with the presumptive diagnosis of primary dysmenorrhea, based upon a typical history of gentle anterior pelvic pain beginning in adolescence and associated specifically with menstrual periods. A history that is inconsistent and/or physical findings of a pelvic mass, abnormal vaginal discharge, or pelvic tendernes that is not limited to the time of the menstrual period give an inkling of a diagnosis of secondary dysmenorrhea. It is appropriate to perform merely an abdominal examination in young adolescents with a typical history who have not ever been sexually active. A pelvic examination should be performed in females who have been sexually active to guard for sexually transmitted diseases of the like kind as chlamydial infection.

When the history and physical examination put in mind of other pelvic pathology, the evaluation should run after accordingly, usually with pelvic ultrasonography as the initial diagnostic touchstone to rule out anatomic abnormalities like as mass lesions. In patients with peremptory dysmenorrhea that is unresponsive to initial treatment, ultrasonography is useful to discover ovarian cysts and endometriomas. (15) It also has reasonably useful ability to detect advanced stage 3 or 4 endometriosis; its concordance with surgical staging is 84 percent 16 Sonovaginography (i.e., transvaginal ultrasonography with saline infusion of the uterus) appears to be better than transvaginal sonography alone in diagnosing rectovaginal endometriosis. (17) Magnetic resonance imaging is limited in its ability to diagnose endometriosis (sensitivity, 69 percent; specificity, 75 percent) (18) The respect standard test for diagnosis and staging of endometriosis is laparoscopy or laparotomy with biopsy. It should be considered when first-line therapies are ineffective and dysmenorrhea causes functional impairment.