Dysmenorrhea in Emergency Medicine
- Author: Andre Holder, MD; Chief Editor: Pamela L Dyne, MD more...
Background
Dysmenorrhea refers to the syndrome of painful menstruation. Its prevalence is estimated at 25% of women and up to 90% of adolescents.[1] No significant difference exists in prevalence or incidence between races, though the most common causes of dysmenorrhea differ by age (see History). Although it is not life-threatening, dysmenorrhea can be debilitating and psychologically taxing for many women. Some choose to self-medicate at home and never seek medical attention for their pain. Dysmenorrhea is responsible for significant absenteeism from work, and it is the most common reason for school absence among adolescents.[1]
Dysmenorrhea can be divided into 2 broad categories: primary and secondary. Primary dysmenorrhea occurs in the absence of pelvic pathology, whereas secondary dysmenorrhea results from identifiable organic diseases.
Pathophysiology
Historical attitudes toward menstrual pain were often dismissive. Pain was often attributed to women's emotional or psychological states and misconceptions about sex and sexual behaviors. Research has now established concrete physiologic explanations for dysmenorrhea, which discredit these prior theories.[1, 2]
Primary dysmenorrhea usually begins within the first 6 months after menarche once a regular ovulatory cycle has been established. During menstruation, sloughing endometrial cells release prostaglandins, which cause uterine ischemia through myometrial contraction and vasoconstriction. Elevated levels of prostaglandins have been measured in the menstrual fluid of women with severe dysmenorrhea. These levels are especially high during the first 2 days of menstruation. Vasopressin may also play a similar role.[1, 3]
Secondary dysmenorrhea may present at any time after menarche, but it most commonly arises when a woman is in her 20s or 30s, after years of normal, relatively painless cycles. Elevated prostaglandins may also play a role in secondary dysmenorrhea, but, by definition, concomitant pelvic pathology must also be present. Common causes include endometriosis, leiomyomata (fibroids), adenomyosis, pelvic inflammatory disease, and intrauterine device (IUD) use.
Note that, though the hormonal link to dysmenorrhea may partially explain its pathophysiology, hormones do not explain the total story. There is a very complex interplay between these hormones, basal body temperature, sleep patterns, and the central nervous system, the extent of which is not completely understood.[1]
Epidemiology
Frequency
United States
Its prevalence is estimated at 25% of women and up to 90% of adolescents.[1]
Mortality/Morbidity
Dysmenorrhea itself is not life threatening, but it can have a profoundly negative impact on a woman's day-to-day life. In addition to missing work or school, she may be unable to participate in sports or other activities, compounding the emotional distress brought on by the pain.
Race
No significant difference exists in prevalence or incidence between races.
Age
The most common causes of dysmenorrhea differ by age (see History).
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