Dysmenorrhea: Contemporary Perspectives

Abstract

Dysmenorrhea affects up to 80% of reproductive age women, in many cases causing sufficient pain to dramatically affect social and occupational roles. The prevalence varies across ethnic groups, which in part may reflect varying cultural attitudes toward women and menstruation. Key identified risk factors for dysmenorrhea include age of menarche, body mass, dietary habits, associated uterine bleeding disorders, comorbid pelvic pathology, and psychosocial problems. While much of the focus on the pathogenesis of dysmenorrhea has focused on aberrant inflammatory mediators in the uterine environment, recent studies using experimental quantitative sensory testing suggest central processing of pain is enhanced in many of these women as well, similar to both irritable bowel syndrome and painful bladder syndrome, which are closely related visceral pain disorders. The mainstays of treatment include nonsteroidal antiinflammatories and combined oral contraceptives; although only the former has extensive level I evidence to support its efficacy. Surgical treatments (presacral neurectomy or uterosacral nerve ablation) appear to be beneficial in a subset of women, but are associated with small, but serious, risks of visceral or vascular injury. Complementary and alternative treatments such as vitamin B1 and magnesium supplementation have not been studied as extensively but show some promise as well. In particular, treatments targeting central aberrations in pain processing, as used in chronic pain management, may prove beneficial as a more multidimensional approach to this common malady is accepted in our field.

The magnitude, long-term trend and lifestyle risk factors of dysmenorrhea and premenstrual syndrome

“…Our results are compatible with previous findings showing adverse effects of smoking in that the risk and/or severity of dysmenorrhea increased with smoking [55,57,175], and that women who were smokers were more likely to have severe pain lasting longer than two days [43]. The primary disease pathogenesis for dysmenorrhea has been related to increased prostaglandin E2 (PGE2) and PGF2α in the menstruating uterus, leading to reduced endometrial blood flow, uterine hypoxia, hyperactive myometrial contractions and subsequent pain [24]. Although the biological mechanisms of the effects of smoking on dysmenorrhea have not been well elucidated, cigarette smoking has been shown to cause vasoconstriction, potentially resulting in dysmenorrhea [57].…”

“…The primary disease pathogenesis for dysmenorrhea has been related to increased prostaglandins in the menstruating uterus, leading to reduced endometrial blood flow and subsequent pain [24]. There is suggestion that endometrial thickness may be influenced by adiposity through its oestrogen-mediated effect [43,200].…”

“…As described before, the vast majority of women of reproductive age are affected by one or more menstrual disorders, the most prevalent being dysmenorrhea and PMS, which may significantly impact on their quality-of-life and cause considerable economic and societal burdens [1,13,23,24]. A better understanding of the magnitude of the conditions in the local context and their trend over time may help policy-makers to plan their resource allocation to better meet the needs of affected women.…”

“…As a debilitating condition, it has a major impact on women's health-related quality-of-life and social and occupational roles, resulting in significant work and school absences [1,24].…”

“…As a debilitating condition, it has a major impact on health-related quality-of-life and social and occupational roles, resulting in significant work and school absences [1,24]. Considerable economic losses due to dysmenorrhea were estimated resulting from costs of medications, medical care and decreased productivity [23].…”