Primary Dysmenorrhea

Introduction

Primary dysmenorrhea is defined as pain occuring in lower abdomen before or during menstrual cycle, in the absence of other diseases such as endometriosis. Primary dysmenorrhea is by far the most common gynaecological problem. It is so common that many females fail to report it in medical interview, even when their daily activities are restricting.

Primary dysmenorrhea can be distinguished from secondary dysmenorrhea by number of factors. Second dysmenorrhea may be indicative if:

1. Dysmenorrhea occurring during first one or two cycles after menarche.
2. Dysmenorrhea occuring after 25 years.
3. Late onset of dysmenorrha after history of painless menstruation (consider complications of pregnancy : ectopic or threatened spontaneous abortion)
4. Pelvic abnormality on physical examination, infertility heavy menstrual flow or irregular menstrual cycle
5. Little or no response to therapy with drugs like NSAIDs, oral contraceptives or both.

Clinical Features

Primary dysmenorrhea usually presents at the age of adolescent within three years of menarche. However, it is unusual for symptoms to start within the first six months after menarche. Females suffering from primary dysmenorrhea may experience sharp, intermittent spasms of pain, usually centered in suprapubic area. Pain may radiate to lower back or back of legs. Systematic symptoms of primary dysmenorrhea may include nausea, vomitting, diarrhoea, fatigue, fever, headache or light-headness.