Primary dysmenorrhea is a painful menstruation without demonstrable pelvic disease.
Symptoms include intermittent painful spasms, crampy labor-like pain localized over the lower abdomen & the suprapubic area which may radiate to the lower back or inner thighs.
The pain may also be described as a dull ache or as a stabbing pain.
Accompanying symptoms include nausea and vomiting, diarrhea, headaches, lightheadedness, fatigue, fever, nervousness & fainting.


  • Primary dysmenorrhea: Painful menstruation without demonstrable pelvic disease

Signs and Symptoms

  • Intermittent painful spasms, crampy, labor-like pain localized over the lower abdomen and the suprapubic area which may radiate to the lower back or inner thighs occurring during and occasionally starting prior to menstruation
    • Pain may also be described as a dull ache or as stabbing pain
  • Accompanying symptoms: Nausea, vomiting, diarrhea, abdominal bloating, headaches, lightheadedness, fatigue, fever, nervousness and fainting
  • A study showed the prevalence of dysmenorrhea to be 16-91% in reproductive-aged women with severe pain occurring in 2-29% 
    • Risk of dysmenorrhea is increased with stress and positive family history of dysmenorrhea
    • It improves with patient’s increased age, parity, and oral contraceptive use

Primary Dysmenorrhea

  • Primary dysmenorrhea symptoms typically start between 6 months-3 years after menarche when ovulatory cycles are established
  • Patient has symptoms as described above
    • Evidence suggests that symptoms of primary dysmenorrhea are caused by prostaglandins PGF and PGE2 that are released from the endometrium at the time of menstruation which cause uterine contractions and decreased blood flow likely causing pain through ischemia
  • Symptoms characteristically occur within 1-4 hours after the onset of menstruation and may last for 12-72 hours
    • Symptoms tend to be the most severe on the first 1-2 days of menstruation when prostaglandin levels are the highest and diminish gradually

Secondary Dysmenorrhea

  • Secondary dysmenorrhea is caused by an underlying pathology and is frequent in women 30-45 years old after having pain-free menstruation 
  • Signs and symptoms that may indicate secondary dysmenorrhea:
    • Dysmenorrhea occurring during the first 1-2 cycles after menarche
      • Consider congenital outflow tract obstruction
    • Dysmenorrhea that occurs after the age of 20 years
    • Late onset of dysmenorrhea after a history of previous menstrual cycles without pain
      • Consider ectopic or threatened spontaneous abortion
    • Pelvic pain occurring at times other than menses
    • Signs of secondary dysmenorrhea caused by endometriosis
      • Progressive dysmenorrhea
      • Family history of endometriosis
      • Dyspareunia
      • Infertility
    • History of pelvic inflammatory disease (PID), sexually transmitted infection (STI), multiple sexual partners or unprotected sex
      • PID may be suspected
    • Intrauterine device (IUD) use
    • Heavy menstrual flow or irregular cycles
      • Consider adenomyosis, fibroids, polyps
    • Urinary, musculoskeletal or gastrointestinal (GI) symptoms
      • Consider non-gynecologic process
    • No significant response to therapy with nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives (OCs), or both
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