Primary dysmenorrhea occurs during regular ovulatory cycles. Women with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions. Prostaglandins are released during menstruation because of the destruction of the endometrial cells and the subsequent release of its contents. br The release of prostaglandins and other mediators of inflammation in the uterus (womb) is thought to be an important factor in primary dysmenorrhea (Wright et al. 2003). Prostaglandin levels have been found to be much higher in women with severe menstrual pain than in women who experience mild or no menstrual pain. Drugs which inhibit prostaglandin production, such as nonsteroidal antiinflammatory drugs (NSAIDs), naproxen, ibuprofen and mefenamic acid, can provide relief for discomfort and other symptoms associated with excessive release of prostaglandins, such as nausea, vomiting and pain head. br cramping associated with dysmenorrhea usually begins a few hours before the onset of bleeding and may continue for a few days. The pain is usually described as being in the lower abdomen, possibly radiating to the thighs and lower back. Other symptoms associated with primary dysmenorrhea are nausea and vomiting, fatigue, diarrhea, lower back pain and headache. brinflammatory drugs (NSAIDs) such as ibuprofen and naproxen, are very effective in the treatment of primary dysmenorrhea. As already noted, their effectiveness comes from its ability to inhibit prostaglandin synthesis. However, many NSAIDs can cause gastrointestinal discomfort as a side effect. Patients who can not take NSAIDs may be prescribed a cyclooxygenase (COX) inhibitor. Oral contraceptives are also sometimes used because they reduce menstrual flow and inhibit ovulation. br Oral contraceptives are the secondline treatment unless a woman is also seeking contraception, then become firstline treatment. Oral contraceptives are 90% effective in improving primary dysmenorrhea and the work of reducing the volume of menstrual blood and the suppression of ovulation. It may take up to 3 months for oral contraceptives to be effective. DepoProvera are also effective, since these methods often induce amenorrhea. br The mechanisms that cause the pain of secondary dysmenorrhea are varied and may or may not include prostaglandins. Some causes of secondary dysmenorrhea are endometriosis, pelvic inflammation, fibroid tumors, adenomyosis, ovarian cysts, and pelvic congestion. The presence of an intrauterine device (IUD) for contraception may also be a potential cause of menstrual pain, although usually only lead to pelvic pain at the time of insertion. Some women also find that using tampons worse menstrual cramps and pain. br symptoms of secondary dysmenorrhea varies with the underlying cause, but the pain usually associated with secondary dysmenorrhea is not limited to the time around menstruation as with primary dysmenorrhea. In addition, secondary dysmenorrhea is lower relative to the onset of menstrual bleeding, occurs in older women and is associated with other symptoms such as infertility. br The most effective treatment of secondary dysmenorrhea is the identification and treatment of underlying cause, despite the measures envisaged by NSAIDs is often helpful. br The first line of treatment is medical (eg, inhibitors of prostaglandin synthetase, hormonal contraception, danazol, progestins). If possible, the underlying disease or anatomical abnormality has been corrected, so that relief of symptoms. br dilation of an operating system can narrow cervical give 3 to 6 months of relief (and allows diagnostic curettage if necessary). Myomectomy, polypectomy, or dilation and curettage may be required. The interruption of the nerves of the uterus by presacral neurectomy and division of the ligaments sacrouterine can help selected patients. Hypnosis may be helpful. br Endometriosis is a common cause of secondary dysmenorrhea. In fact, approximately 24% of women who complain of pelvic pain later that endometriosis. This condition is often associated with infertility. If pain relief is the goal, medical options include hormonal contraception, danazol, progestogens agents, and GnRH agonists. br br
