Primary Dysmenorrhea:

Primary dysmenorrhea is menstrual pain associated with menstrual cycles in the absence of disease findings. The pain usually begins within 1–2 years after the menarche and may become more severe with time. The frequency of cases increases up to age 20 and then decreases with age and markedly with parity. Fifty to 75 percent of women are affected at some time and 5–6% have incapacitating pain.

Clinical Findings:

Primary dysmenorrhea is menstrual pain associated with ovulatory cycles in the absence of pathologic findings. The pain usually begins within 1–2 years after the menarche and may become more severe with time. The frequency of cases increases up to age 20 and then decreases with age and markedly with parity. Fifty to 75 percent of women are affected at some time and 5–6% have very severe pain.

Secondary Dysmenorrhea:

Secondary dysmenorrhea is menstrual pain for which an organic cause exists. It usually begins well after menarche, sometimes even as late as the third or fourth decade of life.

Clinical Findings:

The history and physical examination commonly suggest endometriosis or pelvic inflammatory disease (PID). Other causes may be submucous myoma, IUD use, cervical stenosis with obstruction, or blind uterine horn (rare).

Diagnosis:

Laparoscopy is often needed to differentiate endometriosis from PID. Submucous myomas can be detected most reliably by MRI but also by hysterogram, by hysteroscopy, or by passing a sound or curette over the uterine cavity during D&C. Cervical stenosis may result from induced abortion, creating crampy pain at the time of expected menses with no blood flow; this is easily cured by passing a sound into the uterine cavity after administering a paracervical block.