Dysmenorrhea

The dysmenorrhea is defined as the appearance of abdominal or pelvic pain immediately before menstruation or coinciding with it.

There are two types:

• Primary, when no pelvic disease of organic origin is found.
• Secondary, when the pain is produced by an organic pelvic pathology or, at least, is associated with said pathology.

It is estimated that approximately 50% of women in post-pubertal age suffer from dysmenorrhea, and that around 10% become disabled 1-3 days of each month, this being a major cause of lost hours of school and work attendance in the young woman.

Primary dysmenorrhea usually appears in women under 25 years of age and is more common in nulliparous women (curiously, when these women become pregnant, the symptoms of dysmenorrhea disappear after delivery).

Why is it produced?

The exact cause of primary dysmenorrhea is not known. There is talk of multiple factors that can intervene in its appearance:

• Psychological
• Hormonal
• Cervical
• Uterine contractility
• Uterine blood flow
• Prostaglandins
• The uterine nerves

Regarding secondary dysmenorrhea, it is more frequently associated with:

• Endometriosis
• Infectious processes
• Adenomyosis
• Cervical stenosis
• Pelvic congestion syndrome
• GOD

Primary dysmenorrhea is presumed to be caused by an increase in prostaglandins, which, in turn, leads to increased uterine contractility, leading to ischemia of the uterus.

And these two factors, increased uterine activity and ischemia of the uterus, coupled with increased sensitivity of uterine nerve endings, lead to menstruation pain.

Symptoms of dysmenorrhea

Symptoms do not usually appear in the first menstruations, after menarche, but appear suddenly 1 or 2 years later.

It is characteristic that the pain begins one or two days before the start of menstruation and continues during the first day, although in some cases it can last until the second day.

The pain, which can be more or less acute, is usually located in the midline, above the pubis. Other times it comes in the form of cramps. In addition, there may be general apathy, low back pain, pain in both legs, headaches, nervousness and sometimes nausea. When these episodes are repeated for several months, the psyche and mood are usually affected.

How is it diagnosed?

The diagnosis is made by the medical history and gynecological examination, which, by definition, will be completely negative in primary dysmenorrhea.

In the case of secondary dysmenorrhea, the necessary tests will be carried out to diagnose the possible causes already mentioned above.

Treatment for dysmenorrhea

The treatment of secondary dysmenorrhea is that of the cause that produces it. For primary dysmenorrhea, the following treatments are available:

1. Psychotherapy
2. Hormonal treatment: oral contraceptives are used, which are the treatment of choice for women who do not wish to become pregnant. This treatment stops dysmenorrhea in more than 90% of cases. In principle, a trial treatment of 3-4 months is done, which can be prolonged if it is successful. If it fails, prostaglandin synthesis inhibitors will be used.
3. Inhibitors of prostaglandin synthesis: indomethacin, mefenamic acid, flufenamic acid, ibuprofen, naprosen, etc. They are indicated when oral hormonal contraceptives have failed or when the patient does not wish to use contraception. They have the advantage that they are only administered during the first three days of menstruation.
4. Surgery: cervical dilation, section of the uterosacral ligaments and resection of the presacral. It is indicated when improvement is not achieved with the exposed medications, however, it is advisable to do a laparoscopy first to safely rule out that there is no organic cause responsible for the dysmenorrhea that was not previously diagnosed.

How to avoid it?

As for primary dysmenorrhea, nothing can be done to prevent it, since the cause that produces it is not known.

To prevent secondary dysmenorrhea, it is necessary to avoid, as far as possible, the appearance of the processes associated with it.

You should go to the gynecologist when abdominal or pelvic pain occurs accompanying or preceding menstruation, so that the doctor can assess it and perform the relevant tests in each case.