Primary dysmenorrhea

Primary dysmenorrhea is defined as cramping pain in the lower abdomen occur ring just before or during menstruation, in the absence of other diseases s uch as endometriosis. Prevalence rates are as high as 90 percent. Initial p resentation of primary dysmenorrhea typically occurs in adolescence. It is a common cause of absenteeism and reduced quality of life in women. The pro blem is often underdiagnosed and undertreated. Women with primary dysmenorr hea have increased production of endometrial prostaglandin, resulting in in creased uterine tone and stronger, more frequent uterine contractions. A di agnostic evaluation is unnecessary in patients with typical symptoms and no risk factors for secondary causes. Nonsteroidal anti-inflammatory medicati ons am the mainstay of treatment, with the addition of oral contraceptive p ills when necessary. About 10 percent of affected women do not respond to t hese measures. It is important to consider secondary causes of dysmenorrhea in women who do not respond to initial treatment. Many alternative treatme nts (ranging from acupuncture to laparoscopic surgery) have been studied, b ut the supporting studies are small, with limited longterm follow-up.