Dysmenorrhoea !
Dysmenorrhoea means painful periods; it is often cramping with no disease behind it, but it can be caused by conditions such as endometriosis.
Updated 2026-10-29
Structures involved
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In biochemistry
In physiology
Why it happens
- Arachidonic acid metabolites in inflammation, and the drugs that block them
- Smooth muscle contraction
- Cyclooxygenase (COX-1 and COX-2)
What it is
Painful menstruation. Primary dysmenorrhoea is cramping pain with no pelvic disease; secondary dysmenorrhoea is caused by an underlying condition such as endometriosis or adenomyosis.
Who gets it
One of the most common gynaecological complaints in adolescents and young women, and a frequent cause of missed school and work in Colombia and worldwide.
Causes
- Primary: excess uterine prostaglandins during ovulatory cycles
- Secondary: endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, a copper intrauterine device, cervical stenosis or uterine malformations
Risk factors
- Young age and onset of ovulatory cycles
- Heavy menstrual flow
- Early menarche
- Smoking
- Family history
- Not having given birth
Pathophysiology
When progesterone falls before menstruation, the endometrium releases prostaglandins (especially PGF2α). They cause strong, uncoordinated myometrial contractions and vasoconstriction, leading to uterine ischaemia and pain; they also cause nausea, diarrhoea and headache.
Classification
- Primary: starts in adolescence once cycles become ovulatory, with a normal pelvis
- Secondary: due to pelvic pathology, often starting later or changing in pattern
Symptoms and signs
- Cramping lower abdominal pain starting just before or with the period, usually lasting one to three days
- Pain radiating to the lower back or thighs
- Nausea, vomiting, diarrhoea, headache or dizziness
- In secondary dysmenorrhoea: pain during intercourse, abnormal bleeding or pain outside menses
Diagnosis
- Clinical
- Primary dysmenorrhoea is a clinical diagnosis from typical history and a normal examination; a pelvic examination is not always needed in adolescents with typical symptoms.
- Tests
- Pregnancy test when relevant; tests for sexually transmitted infections if pelvic infection is possible.
- Imaging
- Pelvic ultrasound when secondary causes are suspected or treatment fails; MRI or laparoscopy for suspected endometriosis or adenomyosis.
Differential diagnosis
- Endometriosis
- Adenomyosis
- Pelvic inflammatory disease
- Ovarian cyst or ovarian torsion
- Ectopic pregnancy or miscarriage
- Urinary tract infection or irritable bowel syndrome
Goal of treatment
Relieve pain so the woman can carry on with daily activities, and identify and treat any secondary cause.
Treatment
- Medical
- Non-steroidal anti-inflammatory drugs, started at or just before the onset of pain, are first-line.
- Medical
- Hormonal contraception (combined methods, progestins or the levonorgestrel intrauterine system) reduces prostaglandin production by thinning the endometrium.
- Lifestyle
- Local heat and regular physical exercise are commonly recommended.
- Surgical
- Laparoscopy to diagnose and treat endometriosis when pain persists despite treatment.
Drugs for this condition
Complications
- Missed school or work and reduced quality of life
- Delayed diagnosis of endometriosis or adenomyosis
- Adverse effects of long-term anti-inflammatory use
Prognosis
Primary dysmenorrhoea usually improves with age and often after childbirth, and responds well to treatment. Secondary dysmenorrhoea depends on its cause.
Test yourself
Think of the answer, then tap the question to see it.
Which mediator causes the pain of primary dysmenorrhoea?
Prostaglandins, mainly PGF2α, released from the endometrium, causing myometrial contractions and ischaemia.
What is first-line treatment for primary dysmenorrhoea?
Non-steroidal anti-inflammatory drugs, with hormonal contraception as an alternative or addition.
When does primary dysmenorrhoea typically begin?
In adolescence, once menstrual cycles become ovulatory, usually within a few years of menarche.
Which features suggest secondary dysmenorrhoea?
Onset later in life, worsening pain, pain during intercourse, abnormal bleeding or an abnormal pelvic examination.
What is the most common cause of secondary dysmenorrhoea?
Endometriosis.
Related conditions
- Endometriosis
- Adenomyosis
- Uterine fibroids (leiomyomas)
- Pelvic inflammatory disease
- Ovarian cyst
- Ectopic pregnancy
- Urinary tract infection (acute cystitis)
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Dysmenorrhea (StatPearls (NCBI Bookshelf), 2026).
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