Dysmenorrhea is defined as pelvic pain occurring at or around the time of menses. It is a leading cause of absenteeism for women under age 30. Primary dysmenorrhea is without pathological physical findings. Secondary dysmenorrhea has pain occurring prior to or during menses, often more severe than primary, having a secondary pathologic (structural) cause. 40% of adult females have menstrual pain, and 10% are incapacitated for 1-3 days each month. Primary dysmenorrhea usually affects teens to early 20's. Secondary dysmenorrhea affects women in their 20's to 30's.
The cause of primary dysmenorrhea is considered to be elevated production (2-7 times normal) of prostaglandins and other mediators in the uterus which produce uterine ischemia through platelet aggregation, vasoconstriction and dysrhythmic contractions with pressures higher than the systemic blood pressure.
Risk factors for primary dysmenorrhea include: Nulliparity; Positive family history. Risk factors for secondary dysmenorrhea include: Pelvic infection; Sexually transmitted diseases; and Endometriosis.
The causes of secondary dysmenorrhea include: Congenital abnormalities of uterine or vaginal anatomy; Cervical stenosis; Pelvic infection; Adenomyosis; Endometriosis; and Pelvic tumors - especially leiomyomata (uterine fibroids).
Conventional lab tests include a pelvic exam.
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