Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates Original paper

What was studied?

The study reviewed primary dysmenorrhea (PD), a common condition affecting many women of reproductive age, characterized by painful menstrual cramps that occur in the absence of pelvic pathology. The pain typically begins just before or at the onset of menstruation and lasts for up to 72 hours. The pathophysiology of PD is primarily driven by the elevated levels of prostaglandins, particularly PGF2α and PGE2, which stimulate uterine contractions and vasoconstriction, leading to ischemia, pain, and the activation of pain fibers. The study also examined how the condition affects quality of life (QOL) and identified various treatment options, including both pharmacological and non-pharmacological interventions. The review highlights the prevalence of PD and the negative impact it has on women’s physical and mental health, often resulting in absenteeism from school or work and impaired daily functioning.

Who was studied?

The review provides insights into primary dysmenorrhea based on research and evidence from a variety of clinical studies involving women of reproductive age who experience menstrual cramps. The studies reviewed primarily focus on young females, many of whom experience the onset of PD shortly after menarche, typically within 6 to 24 months. The review draws on data from diverse ethnic and geographic populations to provide a comprehensive overview of the condition, its impact on life, and the available treatment methods. It also includes various therapeutic interventions, such as nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives, and non-pharmacological approaches like exercise, yoga, and acupuncture.

Most important findings

The primary finding of this study is the significant role of prostaglandins (PGF2α and PGE2) in the pathogenesis of primary dysmenorrhea. Elevated prostaglandin levels in the uterine tissues lead to intense contractions, ischemia, and hypoxia, which cause pain during menstruation. Women with PD experience higher levels of these prostaglandins compared to those without the condition, particularly in the luteal phase of their menstrual cycle. Additionally, the study underscores the broad physical and psychological impact of PD. Symptoms extend beyond pain and include fatigue, headaches, sleep disturbances, nausea, gastrointestinal issues, and emotional disturbances such as anxiety and depression.

Treatment for PD is typically aimed at reducing pain and improving quality of life (QOL). The most commonly recommended pharmacological treatments include NSAIDs and hormonal contraceptives, which help by reducing prostaglandin synthesis and regulating hormonal levels. However, the study emphasizes the need for a personalized approach to treatment, as some women may experience inadequate relief from standard therapies. Non-pharmacological interventions, such as exercise, yoga, acupuncture, and TENS (transcutaneous electrical nerve stimulation), also provide relief for many women, but their efficacy varies, and further research is required to confirm their long-term benefits.

Key implications

The review highlights the need for better diagnosis, management, and education around PD. Despite being a common condition, PD is often underreported and inadequately treated. Women frequently endure severe symptoms without seeking medical advice due to embarrassment or the belief that menstrual pain is a natural, unavoidable part of menstruation. The review emphasizes that healthcare providers should focus on early intervention and educate women about available treatments. Additionally, considering the significant impact of PD on QOL, including absenteeism from school and work, healthcare providers must take a more proactive approach in both diagnosing and offering tailored treatment plans. Non-pharmacological interventions should be considered as adjuncts to standard treatments to improve overall patient outcomes, and the efficacy of these therapies should be further explored through well-designed studies.