| One-Minute Clinician

Dysmenorrhea: The Most Common Women's Pain Complaint

Dysmenorrhea is simply defined as chronic cyclical pelvic pain and it's almost always associated with menstruation. It's a syndrome that's unique to women, and it's very common. Dysmenorrhea can start very early in a woman's life, as soon as they start menstruating, which is the definition of primary dysmenorrhea. It can sometimes start a little bit later after they've had a period of no pain, and that's secondary dysmenorrhea. In either case, dysmenorrhea is something that affects very young reproductive age women. The problem is that a lot of people think it's normal. Almost 95 percent of women report having some pain during menstruation, and about 25 percent of those have chronic severe debilitating pain. We actually classify that as a chronic pain syndrome. It causes a lot of physiologic changes in the body, in the periphery, and in the brain that are similar to other chronic pain syndromes. What happens when patients are left untreated is they're essentially being sensitized. And that changes the way their central nervous system works and the way their central nervous system deals with pain.

Dysmenorrhea is a unique syndrome in that we have a chance to intervene very early on. And so, if we can teach providers to identify when it first comes on, we may be actually able to prevent these women from developing a chronic pain syndrome. We don't have that opportunity for many other chronic pain syndromes, but we have that opportunity in dysmenorrhea. It is quite easy to treat early on, starting with a variety of NSAIDs. There are at least 10 that are available on the market now, FDA-approved for use in menstrual pain. We also have suppression with oral contraceptives; in other words, suppress menstruation fully and not allow patients to go through cyclical period of pain. I think a lot of people used to be worried about using hormones continuously in young women, but in dysmenorrhea, it can be done safely. We have the levonorgestrel IUD which is an intrauterine device that can be inserted in women who are older and they're done with child bearing. We can do endometrial ablations to stop menstruation. We have GNRH agonist which we can use to stop menstruation. And finally, for women who are in severe pain, they may be amendable to surgical interventions such as a hysterectomy. So the beautiful thing about dysmenorrhea is that, it's preventable and it's treatable. We just have to know about it.

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