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[Conditions](https://durgical.com/en/conditions/) · [Pelvis](https://durgical.com/en/anatomy/region/pelvis/)

# 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

Tap one to see what it is and open it in 3D.

- [Myometrium](https://durgical.com/en/anatomy/myometrium/)
- [Endometrium](https://durgical.com/en/anatomy/endometrium/)
- [Body of uterus](https://durgical.com/en/anatomy/body-of-uterus/)
- [Uterine artery](https://durgical.com/en/anatomy/uterine-artery/)
- [Uterosacral ligament](https://durgical.com/en/anatomy/uterosacral-ligament/)
- [Cervix](https://durgical.com/en/anatomy/cervix-of-uterus/)

## In biochemistry

- [Eicosanoids: prostaglandins, thromboxanes and leukotrienes](https://durgical.com/en/biochemistry/topics/eicosanoids-prostaglandins-thromboxanes-and-leukotrienes/)

## In physiology

- [The menstrual cycle: ovary and endometrium](https://durgical.com/en/physiology/the-menstrual-cycle-ovary-and-endometrium/)

## Why it happens

- [Arachidonic acid metabolites in inflammation, and the drugs that block them](https://durgical.com/en/general-pathology/arachidonic-acid-metabolites-in-inflammation-and-the-drugs-that-block-them/)
- [Smooth muscle contraction](https://durgical.com/en/physiology/smooth-muscle-contraction/)
- [Cyclooxygenase (COX-1 and COX-2)](https://durgical.com/en/biochemistry/enzymes/cyclooxygenase/)

## 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](https://durgical.com/en/anatomy/region/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

## Red flags

- New dysmenorrhoea starting after about age 25, or pain that keeps worsening
- Pain with fever, abnormal discharge or pain during intercourse
- Abnormal bleeding or an abnormal pelvic examination
- No improvement with anti-inflammatory and hormonal treatment

## 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](https://durgical.com/en/anatomy/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

- [Ibuprofen](https://durgical.com/en/pharmacology/ibuprofen/)
- [Celecoxib](https://durgical.com/en/pharmacology/celecoxib/)
- [Naproxen](https://durgical.com/en/pharmacology/naproxen/)

## 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.

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## Related conditions

- [Endometriosis](https://durgical.com/en/conditions/endometriosis/)
- [Adenomyosis](https://durgical.com/en/conditions/adenomyosis/)
- [Uterine fibroids (leiomyomas)](https://durgical.com/en/conditions/uterine-fibroids/)
- [Pelvic inflammatory disease](https://durgical.com/en/conditions/pelvic-inflammatory-disease/)
- [Ovarian cyst](https://durgical.com/en/conditions/ovarian-cyst/)
- [Ectopic pregnancy](https://durgical.com/en/conditions/ectopic-pregnancy/)
- [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Dysmenorrhea](https://www.ncbi.nlm.nih.gov/books/NBK560834/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/dysmenorrhoea/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/dysmenorrhoea/