Primary Dysmenorrhea: Assessment and Treatment

Abstract

Primary dysmenorrhea is defined as menstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of the menstrual cycle. It has major implications for quality of life, such as limitation of daily activities and psychological stress, being one of the main causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, non-pharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments' contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.

Living with Restrictions. The Perspective of Nursing Students with Primary Dysmenorrhea

“…At present, there are few qualitative studies [19][20][21][22] that describe and analyse the perspective and experience of young female students suffering from dysmenorrhea and how it influences their daily lives. Previous studies [19][20][21]23] have reported how dysmenorrhea limits women's daily life. Chen et al [19] reported that the effects of dysmenorrhea can include difficulty in sitting and walking, the need to adopt antalgic positions (sleeping in foetal position), absenteeism from university classes and/or work, abandonment of family responsibilities (accompanying children to school) and recreational activities.…”

Vitamin D supplementation for primary dysmenorrhea: a double-blind, randomized, placebo-controlled trial

“…Upregulation of cyclooxygenase activity and prostaglandin synthesis are observed in women with dysmenorrhea [10]. Accordingly, nonsteroidal antiinflammatory drugs (NSAIDs), which inhibit the expression of cyclooxygenase enzyme involved in the synthesis of prostaglandin, are used as the first-line treatment of primary dysmenorrhea [11]. These drugs are effective in managing primary dysmenorrhea; however, treatment with NSAIDs is also associated with several side effects, such as stomach pain and heartburn, increasing the risk of stomach ulcer and gastrointestinal bleeding [12,13].…”

Network Pharmacology Strategy to Investigate the Pharmacological Mechanism of Siwu Decoction on Primary Dysmenorrhea and Molecular Docking Verification

“…Oral contraceptives and nonsteroidal anti-inflammatory drugs (NSAIDs) have been prescribed as first choice of treatment in PDM [3,4]. However, these drugs have adverse effects, and their long-term effects are less than optimal.…”