• Dysmenorrhea is the medical term for pain with menstruation.
  • There are two types of dysmenorrhea: “primary” and “secondary”.

Primary dysmenorrhea 

  • Common menstrual cramps that are recurrent
  • Pain usually begins 1 or 2 days before, or when menstrual bleeding starts
  • Felt in the lower abdomen, back, or thighs. 
  • Pain can range from mild to severe, can typically last 12 to 72 hours
  • Accompanied by nausea-and-vomiting, fatigue, and even diarrhea.

Secondary dysmenorrhea 

  • Pain that is caused by a disorder in the woman’s reproductive organs
  • Endometriosis, 
  • Adenomyosis
  • Uterine fibroids
  • Infection.
  •  Pain begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. 
  • The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.


  • Contractions  in the uterus by a chemical called prostaglandin.
  • During menstruation, the uterus contracts more strongly.
  • If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus.
  • Pain results when part of the muscle briefly loses its supply of oxygen.

Menstrual pain from secondary dysmenorrhea:

  • Endometriosis  A condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus.
  • Adenomyosis – A condition where the lining of the uterus grows into the muscle of the uterus.
  • Pelvic inflammatory disease – An infection caused by bacteria that starts in the uterus and can spread to other reproductive organs.
  • Cervical stenosis – Narrowing of the opening to the uterus.
  • TB
  • One horn of malformed uterus
  • Fibroids (benign tumors) – Growths on the inner wall of the uterus.


  • Aching pain in the abdomen (pain may be severe at times)
  • Feeling of pressure in the abdomen
  • Pain in the hips, lower back, and inner thighs
  • Secondary dysmenorrhea is Present just before menstruatio
  • In Secondary dysmenorrhea The pain may persist for 12 – 24 hours
  • Dyspareunia is seen in Secondary dysmenorrhea 


  • Pelvic exam: speculum is inserted and vagina, cervix, and uterus are examined.
  • Any lumps or changes, and a small sample of vaginal fluid may be taken for testing.


  • To relieve mild menstrual cramps:
  • Ibuprofen 
  • Aspirin or another pain reliever such as acetaminophen.
  • Place a heating pad or hot water bottle on your lower back or abdomen.
  • Rest when needed.
  • Avoid foods that contain caffeine.
  • Avoid smoking and drinking alcohol.
  • Massage of lower back and abdomen. 
  • Oral contraceptives may be prescribed because women who take oral contraceptives have less menstrual pain.
  • Hysterectomy is the definitive treatment and as with other conditions, the type of surgical procedure depends on uterine size and associated uterine or abdominopelvic pathology.

Exam Question

  • Dysmenorrhea & Menorrhagia are Symptoms of adenomyosis
  • Treatment of choice in a young patient with primary dysmenorrhea is Symptomatic
  • One horn of malformed uterus, Endometriosis with unilateral distribution & Small fibroid at the utero tubal junction are Cause of unilateral dysmenorrhea
  • Cause of secondary dysmenorrhea in a young female are TB, Subserous fibroid & Endometriosis
  • Secondary dysmenorrhea is Present just before menstruation 
  • In Secondary dysmenorrhea The pain may persist for 12 – 24 hours
  • Dyspareunia is seen in Secondary dysmenorrhea 
  •  Hysterectomy is definitive treatment of adenomyosis
Don’t Forget to Solve all the previous Year Question asked on Dysmenorrhea

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