Diagnosis

The diagnosis of dysmenorrhea is based mainly on history and physical examination. Usually, the clinical features that a patient exhibits — specifically the symptoms she complains of and the signs noted on examination — are sufficient to make the diagnosis of this disease. Primary dysmenorrhea is too frequently diagnosed on the basis of exclusion of other causes of dysmenorrhea and instead should be diagnosed by its clinical features [Dawood, 1985].

Features of Primary Dysmenorrhea

The disorder usually begins within 6 to 12 months after menarche, when ovulatory cycles are established [Dawood, 1985]; pain usually begins before or with menses, peaks after 24 hours, and subsides after 2 days. Researchers generally agree that primary dysmenorrhea is usually associated with ovulatory cycles. However, some studies suggest that this is not always the case. In one study, researchers found that "dysmenorrhea occurs even during the first periods after menarche since 72% of our patients with dysmenorrhea reported onset of their symptoms at that time" [Svanberg, 1981]. Another study stated that "ten out of 12 girls followed longitudinally from menarche reported dysmenorrhea in the first menstrual cycles after menarche. This indicates that one has to be critical about the statement that dysmenorrhea occurs only in ovulatory cycles" [Flug, 1985].

Other features of primary dysmenorrhea may include lower abdominal pain, usually crampy or labor-like; headache; nausea; constipation or diarrhea; urinary frequency; and pain that improves with abdominal massage or counter pressure. Vital signs, bowel sounds, and pelvic examination are usually normal.

Features of Secondary Dysmenorrhea

Secondary dysmenorrhea usually occurs many years after menarche. A history of dysmenorrhea that begins more than 2 years after menarche may indicate secondary dysmenorrhea. Pain can begin any time in the cycle and can occur in an anovulatory cycle. Pain beginning more than a few hours or as much as several days before onset of menses is more likely to be secondary dysmenorrhea.

This disease can be caused by cervical stenosis, adenomyosis, fibroids, uterine polyps, adhesions, ovarian cysts, IUDs, pelvic inflammatory disease and infections, bowel and bladder tumors, and inflammatory bowel disease. Secondary dysmenorrhea caused by endometriosis often resembles primary dysmenorrhea.

References

Dawood MY. Dysmenorrhea. J Reprod Med. 1985;30(3): 154-167.

Flug D, Largo RJ, Prader A. Symptoms related to menstruation in adolescent Swiss girls: a longitudinal study. Annals Hum Biol. 1985;12(2);161-168.

Svanberg L, Ulmsten U. The incidence of primary dysmenorrhea in teenagers. Arch Gynecol. 1981;230:173-177.

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