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Introduction

Primary dysmenorrhea is a common gynecologic condition characterized by painful pelvic cramping that begins 1-2 days before the onset of menses and then resolves several days after the onset of bleeding.

Pathophysiology and risk factors

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.  This causes the pain symptoms associated with the onset of menses.  The local release of inflammatory mediators and prostaglandins also affects the gastrointestinal system, resulting in associated diarrhea, nausea, and bloating.

Several factors can increase the likelihood of developing primary dysmenorrhea.  These include adolescence (the most common gynecologic issue in this population), tobacco use, and stress.

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