EpistemisDysmenorrhea
Specialty: Gynecology and breast.
Why it occurs
- Primary dysmenorrhea (excess production of prostaglandins F2-alpha in the secretory endometrium causing hypertonic myometrial uterine contractions and local ischemia, typically without structural pathology)
- Endometriosis or adenomyosis (ectopic implants of endometrial tissue outside the uterus or in the myometrium that bleed and cause cyclical painful peritoneal inflammation)
- Intramural or submucosal uterine fibroids (which make it difficult to expel menstrual flow, requiring greater uterine contractility)
- Chronic pelvic inflammatory disease (pelvic adhesions and scars secondary to previous gynecological infections)
- Stenosis or narrowing of the cervical canal (anatomical obstruction to the passage of menstrual flow that increases intrauterine pressure)
Initial workup
High resolution transvaginal gynecological ultrasound to evaluate uterine morphology (detection of fibroids, adenomyosis or endometriotic cysts/endometriomas in ovaries); cervical microbiological screening (smear and culture of exudate, PCR for Chlamydia and Neisseria); Pelvic MRI if deep infiltrating endometriosis is suspected; diagnostic laparoscopy with direct visualization and histopathology (gold standard for peritoneal endometriosis).
red flags
Late-onset secondary dysmenorrhea (in people over 25-30 years of age) that progressively worsens and does not respond to conventional analgesics, associated with fever, foul-smelling vaginal discharge, intolerable deep dyspareunia, or menstrual bleeding so abundant that it causes syncope or severe anemia.
Standard management
- Ibuprofen — 400-600 mg every 8 hours orally) or Naproxen (250-500 mg every 12 hours orally; NSAIDs that inhibit the enzyme cyclooxygenase, reducing the synthesis of prostaglandins F2-alpha. It is recommended to start treatment 24-48 hours before the expected start of menstruation
- Combined oral contraceptives — ethinyl estradiol with levonorgestrel or drospirenone, administered daily to suppress ovulation, thin the endometrium, and dramatically reduce menstrual pain and bleeding
- Levonorgestrel intrauterine device (Mirena IUD, continuously releases local progestogen causing deep endometrial atrophy, very effective for dysmenorrhea due to adenomyosis or endometriosis).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 3