gynecology and obstetrics
Dysmenorrhea
Etiology of Dysmenorrhea
Dysmenorrhea can be Primary (more common) Secondary (due to other disorders) Primary dysmenorrhea is idiopathic and cannot be explained by other gynecologic disorders ( Etiology reference ). Pain is thought to result from uterine contractions and ischemia, probably mediated by prostaglandins (eg, prostaglandin F2-alpha, a potent myometrial stimulant and vasoconstrictor) and other inflammatory mediators produced in secretory endometrium and possibly associated with prolonged uterine contractions and decreased blood flow to the myometrium. Contributing factorsmay include the following: Passage of menstrual tissue through the cervix High levels of prostaglandin F2-alpha in menstrual fluid A narrow cervical os A malpositioned uterus Anxiety Primary dysmenorrhea typically begins within a year after menarche and occurs almost invariably in ovulatory cycles. The pain usually begins when menses start (or just before) and persists for the first 1 to 2 days; this pain, described as spasmodic, is superimposed over constant lower abdominal pain, which may radiate to the back or thigh. Patients may also have malaise, fatigue, nausea, vomiting, diarrhea, low back pain, or headache. Risk factors for severe symptomsinclude the following: Early age at menarche Long or heavy menstrual periods Smoking A family history of dysmenorrhea Symptoms tend to lessen with increasing age and after a first pregnancy. Symptoms of secondary dysmenorrhea are due to pelvic abnormalities. Almost any abnormality or process that can affect the pelvic viscera can cause dysmenorrhea. Common causesof secondary dysmenorrhea include Endometriosis (the most common cause) Uterine Adenomyosis None Uterine Fibroids None include congenital malformations (eg, bicornuate uterus, subseptate uterus, transverse vaginal septum), ovarian cysts and tumors, Pelvic Inflammatory Disease (PID) , pelvic congestion, intrauterine adhesions, and In a few women, pain occurs when the uterus attempts to expel tissue through an extremely tight cervical os (secondary to conization, loop electrosurgical excision procedure [LEEP], or cryotherapy). Pain occasionally results from a pedunculated submucosal fibroid or an endometrial polyp protruding through the cervix. Risk factorsfor severe secondary dysmenorrhea are the same as those for primary. Secondary dysmenorrhea usually begins during adulthood unless caused by congenital malformations. 1.Iacovides S, Avidon I, Baker FC: What we know about primary dysmenorrhea today: A critical review.Hum Reprod Update21 (6):762–778, 2015. doi: 10.1093/humupd/dmv039. Epub 2015 Sep 7. 