Dysmenorrhea is one of the most common gynecological symptoms affecting the quality of life of menstruating women.[1] [2] [3] [4] It is experienced as lower abdominal pain or uterine cramps that occur during the few days prior to and/or during menstruation, and usually subsides at the end of menstruation.
Dysmenorrhea is subcategorized into primary and secondary, although it is not always easy to distinguish between the two based on history and exam alone:
- Primary dysmenorrhea occurs in the absence of pelvic pathology
- Secondary dysmenorrhea occurs in the presence of pelvic pathology.
The prevalence is difficult to determine because different definitions and criteria are used, and dysmenorrhea is often underestimated and undertreated.[5] [6] The reported prevalence of dysmenorrhea varies substantially.[7] According to a systematic review by the World Health Organization in 2006, the prevalence of dysmenorrhea in menstruating women is between 16.8% and 81%.[8] A greater prevalence is generally observed in young women, with estimates ranging from 67% to 90% for those aged 17-24 years.[7] [9] [10] An Australian study found that a higher proportion, 93%, of teenagers reported menstrual pain.[11] Studies in adult women are less consistent, with rates varying from 15% to 75%.[7] [9] Dysmenorrhea can lead to absenteeism from work or school, with up to 50% reporting at least one episode of absence, and 5% to 14% reporting frequent absence.[12]
Factors that correlate positively with dysmenorrhea are smoking, early menarche, nulliparity, and family history.[13] [14] Dysmenorrhea is not associated with the duration of the menstrual cycle, but it usually coexists with heavy menstrual bleeding. Many women experience delays in diagnosis and management.[15] Validated questionnaires of patient reported outcomes may be useful in the initial assessment of dysmenorrhea and in assessing response to treatment.[16]
