Medical expert of the article
New publications
Pubertal dysmenorrhea
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
From a modern neurophysiological standpoint, the term "dysmenorrhea" denotes a wide range of neurovegetative, metabolic-endocrine, mental and emotional abnormalities, the leading manifestation of which is pain syndrome caused by the pathological accumulation in the endometrium on the eve of menstruation of arachidonic acid degradation products (prostaglandins, thromboxanes, leukotrienes and monoamino acids), which enhance the afferentation of impulses that irritate pain centers in the central nervous system.
Dysmenorrhea is painful menstruation. Primary dysmenorrhea begins during puberty and is not associated with anatomical abnormalities of the pelvic organs. Secondary dysmenorrhea usually begins in older age and is caused by diseases of the pelvic organs. The diagnosis of primary dysmenorrhea is established on the basis of clinical data, with pelvic ultrasonography excluding anatomical changes and other clinical causes. Pain is relieved with nonsteroidal anti-inflammatory drugs and sometimes low-dose estrogen-progestin contraceptives. In secondary dysmenorrhea, the underlying pathology is treated.
ICD-10 codes
- N94.4 Primary dysmenorrhea.
- N94.5 Secondary dysmenorrhea.
- N94.6 Dysmenorrhea, unspecified.
What causes dysmenorrhea?
Primary dysmenorrhea is the most common. This condition begins during puberty and tends to decrease with age and after childbirth. The pain is thought to be a result of uterine contractions and ischemia associated with the production of prostaglandins in the secretory endometrium. A combination of factors may lead to disruption of the outflow of menstrual blood through the cervix, a narrow cervical canal, or an abnormally positioned uterus.
Common causes of secondary dysmenorrhea include endometriosis, adenomyosis, fibroids, and in some women, cervical canal closure (as a result of conization, cryocoagulation, or thermocauterization), which result in painful periods. The pain is sometimes the result of a submucosal fibroid or endometrial polyp growing through the cervix.
Pathogenesis of dysmenorrhea in puberty
Primary dysmenorrhea is a cyclic pathological process that occurs with menarche or 1.5-2 years after the establishment of ovulatory cycles. An obligatory attribute of functional dysmenorrhea is the absence of organic pathology of the genitals. Secondary dysmenorrhea is one of the striking clinical symptoms of organic pathology of the pelvic organs. Possible causes of secondary dysmenorrhea are external and internal endometriosis, malformations of the uterus and vagina, salpingitis and endometritis, uterine myoma, tumors of the appendages, adhesions in the pelvis, cervical stenosis, intrauterine pathology (polyps, submucous myoma, synechia), foreign body in the uterine cavity, anomalies in the development of blood vessels and the mesentery of the ovaries.
Symptoms of dysmenorrhea in puberty
Pelvic pain may occur with the onset of menstruation or 1-3 days before menstruation. The pain may peak 24 hours after the onset of menstruation and subside after 2-3 days. The pain is usually sharp, but may be aching, and may radiate to the lower back and legs. Headache, nausea, sometimes vomiting, constipation or diarrhea, and urinary disorders may occur. Symptoms of premenstrual syndrome may occur at the onset or throughout menstruation. Primary dysmenorrhea is suspected if symptoms appear shortly after menarche or during puberty. Secondary dysmenorrhea is suspected if symptoms appear after puberty.
What's bothering you?
Diagnosis of dysmenorrhea during puberty
Diagnosis is based on the anamnesis and clinical symptoms of the disease. For differential diagnosis of primary and secondary dysmenorrhea, anatomical changes in the pelvic organs are excluded by clinical examinations, pelvic ultrasonography and examination for other disorders.
[ 5 ]
Who to contact?
Treatment of dysmenorrhea during puberty
Symptomatic treatment of dysmenorrhea begins with adequate rest and sleep and regular exercise. Women with primary dysmenorrhea are examined to exclude anatomical changes in the pelvic organs. Persistent pain due to primary or secondary dysmenorrhea requires drug therapy; nonsteroidal anti-inflammatory drugs are administered starting 24-48 hours before menstruation and continuing for 12 days after the onset of menstruation. If this treatment is ineffective, ovulation suppression with low-dose estrogen-progestin oral contraceptives is recommended. Hypnosis is sometimes useful. In severe pain of unknown origin, interruption of the uterine innervation by presacral neurectomy and dissection of the uterosacral ligaments may help.
What is the prognosis for dysmenorrhea?
If the etiology of dysmenorrhea is clarified and treatment of the disorder is started in a timely manner, dysmenorrhea has a favorable prognosis in relation to further reproductive function.
Использованная литература