Dysmenorrhea

Reda Bassali, MD

Definition: Difficult menstrual flow

Classification: Primary (no uterine abnormality) and Secondary (uterine or ovarian abnormality): e.g. endometriosis, PID, polyps, ovarian cysts, pelvic adhesions.

Pathogenesis: Prostaglandins the mediators; anovulatory cycles have less prostaglandins, and therefore, less dysmenorrhea.

Symptoms:

Pain: spasmodic, crampy, pain in lower abdomen that may radiate to back and thighs; starts with or after the beginning of menstrual flow and lasts 48-72 hours.
Systemic symptoms: nausea, vomiting fatigue, nervousness, dizziness, and diarrhea and headaches.

Physical Exam: Only need to do a speculum exam if sexually active, if atypical pain or if there is a poor response to therapy; in other words if secondary suspected.

Primary Dysmenorrhea:

a. Starts 6-12 m after menarche
b. Pain starts with or after beginning of flow
c. Pain lasts 48-72 hours
d. No speculum exam
e. Lab workup: not indicated
f. x-ray evaluation: none indicated

Secondary Dysmenorrhea:

a. starts > 18 months after menarche
b. starts 2-3 days before flow
c. other findings: dyspareunia, infertility
d. speculum exam - expect abnormality
e. lab workup: preg. test, STD screening, UA, CBC, ESR
f. Ultrasound

Treatment of Dysmenorrhea:

1. Oral Contraceptives: if sexually active; may give Depo-Provera - will work in 80% of primary.

2. NSAIDs (inhibit Prostaglandin synthesis):

Name of NSAIDs	Dosage of medication	Frequency of medication
1. Ibuprofen	400-600 mg	q 6 hours
2. Naproxen (Naprosyn)	Loading: 500 mg dose then 250 mg	q 6-8 hours
3. Naproxen sodium (Aleve) (Anaprox)	Loading: 550 mg dose then 275 mg	q 6-8 hours
4. Mefenamic acid	250 mg	q 6 hours

Department of Pediatrics | Medical College of Georgia
Please email comments, suggestions or questions to:
John T. Benjamin M.D., jbenj@mcg.edu

February 27, 2004

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