Primary spasmodic dysmenorrhea

Specialty: Gynecology and breast.

• Essential period pain
• early onset idiopathic dysmenorrhea
• severe menstrual cramps without organic cause

Why it occurs

• Excessive endometrial production of series 2 prostaglandins (PGF2-alpha and PGE2) during the late luteal phase and menstruation, which triggers dysrhythmic myometrial contractions, uterine hypertonia and transient local ischemia
• Accentuated myometrial vasoconstriction secondary to elevated vasopressin levels
• Constitutional factors and decreased pain threshold in adolescence

Initial workup

Detailed history (it usually begins 1-2 years after menarche, coinciding with the establishment of stable ovulatory cycles). Basic pelvic physical examination and transvaginal or transabdominal ultrasound (in patients who have not started intercourse) to rule out obstructive anomalies of the genital tract (imperforate hymen, vaginal septum) or secondary organic pathology.

Standard management

• Ibuprofen 400-600 mg orally every 8 hours — starting treatment 24 hours before expected bleeding or at the first sign of pain and maintaining it for 2-3 days
• Naproxen 250-500 mg orally every 12 hours with gastric protector
• Combined contraceptives (low-dose oral, vaginal ring or transdermal patches) of choice if the patient also requires birth control (note: the early use of local heat on the lower abdomen can be an effective analgesic adjuvant comparable to NSAIDs).