Primary dysmenorrhea is common in adolescents (up to 90%). At the onset of menarche, adolescents typically have irregular, nonpainful menses due to the lack of ovulation from an immature hypothalamic-pituitary-ovarian axis.  As this axis matures, ovulation can cause excessive endometrial prostaglandin release during menses, which results in lower abdominal cramping and other associated symptoms (eg, fatigue, dizziness, diarrhea) known as primary dysmenorrhea.

JUH→ athletes are less likely to have dysmenorrhea due to them having anovulatory cycles.

During menses, the endometrium produces and releases prostaglandins, which stimulate uterine contractions and promote endometrial sloughing.  Patients with primary dysmenorrhea have increased endometrial prostaglandin production, which causes uterine hypercontractility, hypertonicity, vasoconstriction, and resultant ischemia.

Classic symptoms include:

• Cramping, midline lower abdominal pain beginning 1 or 2 days prior to menses and radiating to the lower back and thighs (ie, uterine hypercontractility and hypertonicity)
  • Usually beginning 1 or 2 days prior to menses (as uterine contractions initiate endometrial sloughing) and resolving a few days after onset of menses (as the endometrial lining thins).
  • Symptoms are typically worse during the first few days of menses and can interfere with daily activities.
• And Associated Systemic symptoms such as nausea, vomiting, and diarrhea (ie, prostaglandin-induced stimulation of the gastrointestinal tract)
• Patients have a normal pelvic examination and no chronic pain symptoms.

Can be diagnosed based on history alone and does not require physical examination.

<aside> 💡 Both treatments are first line and may be used separately depending on patient’s wants and needs ex OCPs are irst-line treatment for sexually active patients who want contraception First-line treatment in nonsexually active patients, such as this one, with primary dysmenorrhea is nonsteroidal anti-inflammatory drugs because they inhibit prostaglandin synthesis.  In sexually active patients, combination oral contraceptives are an option because they suppress ovulation, providing contraception as well as decreasing prostaglandin release.

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<aside> 💡 Mittelschmerz pain, caused by peritoneal inflammation from ovarian follicle rupture, occurs during ovulation, approximately 2 weeks prior to menses, rather than during menses.

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• primary dysmenorrhea treatment details

<aside> 💡 Most women have decreasing symptoms with increasing age.

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• EDUCATONAL OBJECTIVES

(choice A) Pelvic ultrasonography is indicated in suspected secondary dysmenorrhea to rule out organic causes such as pelvic infection or endometriosis. Since physical examination shows no abnormalities (e.g., rectovaginal tenderness, adnexal masses), the history is inconsistent with secondary dysmenorrhea (e.g., lack of pre- or postmenstrual bleeding, dyspareunia), and the patient initially responded to NSAIDs, no further diagnostics are required and treatment should be initiated. Reassessment of therapy should be performed every 6 months and pelvic ultrasonography can be performed if there is no relief of symptoms or new evidence for organic causes of dysmenorrhea.