What we know about primary dysmenorrhea today: a critical review
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Open Access
- 7 September 2015
- journal article
- review article
- Published by Oxford University Press (OUP) in Human Reproduction Update
- Vol. 21 (6), 762-778
- https://doi.org/10.1093/humupd/dmv039
Abstract
Primary dysmenorrhea, or painful menstruation in the absence of pelvic pathology, is a common, and often debilitating, gynecological condition that affects between 45 and 95% of menstruating women. Despite the high prevalence, dysmenorrhea is often poorly treated, and even disregarded, by health professionals, pain researchers, and the women themselves, who may accept it as a normal part of the menstrual cycle. This review reports on current knowledge, particularly with regards to the impact and consequences of recurrent menstrual pain on pain sensitivity, mood, quality of life and sleep in women with primary dysmenorrhea. Comprehensive literature searches on primary dysmenorrhea were performed using the electronic databases PubMed, Google Scholar and the Cochrane Library. Full-text manuscripts published between the years 1944 and 2015 were reviewed for relevancy and reference lists were cross-checked for additional relevant studies. In combination with the word ‘dysmenorrhea’ one or more of the following search terms were used to obtain articles published in peer-reviewed journals only: pain, risk factors, etiology, experimental pain, clinical pain, adenomyosis, chronic pain, women, menstrual cycle, hyperalgesia, pain threshold, pain tolerance, pain sensitivity, pain reactivity, pain perception, central sensitization, quality of life, sleep, treatment, non-steroidal anti-inflammatory drugs. Women with dysmenorrhea, compared with women without dysmenorrhea, have greater sensitivity to experimental pain both within and outside areas of referred menstrual pain. Importantly, the enhanced pain sensitivity is evident even in phases of the menstrual cycle when women are not experiencing menstrual pain, illustrating that long-term differences in pain perception extend outside of the painful menstruation phase. This enhanced pain sensitivity may increase susceptibility to other chronic pain conditions in later life; dysmenorrhea is a risk factor for fibromyalgia. Further, dysmenorrheic pain has an immediate negative impact on quality of life, for up to a few days every month. Women with primary dysmenorrhea have a significantly reduced quality of life, poorer mood and poorer sleep quality during menstruation compared with their pain-free follicular phase, and compared with the menstruation phase of pain-free control women. The prescribed first-line therapy for menstrual pain remains non-steroidal anti-inflammatory drugs, which are effective in relieving daytime and night-time pain. Further study is needed to determine whether effectively blocking dysmenorrheic pain ameliorates risk for the development of chronic pain disorders and to explore whether it is possible to prevent the development—and not just treat—severe dysmenorrheic pain in adolescent girls. In conclusion, we demonstrate the extensive multi-factorial impact of dysmenorrhea and we encourage and direct researchers to necessary future studies.Keywords
This publication has 199 references indexed in Scilit:
- Changes in regional gray matter volume in women with chronic pelvic pain: A voxel-based morphometry studyPain, 2012
- Efficacy of ethinylestradiol 20 µg/drospirenone 3 mg in a flexible extended regimen in women with moderate-to-severe primary dysmenorrhoea: an open-label, multicentre, randomised, controlled studyBMJ Sexual & Reproductive Health, 2012
- The contribution of pain and depression to self-reported sleep disturbance in patients with rheumatoid arthritisPain, 2012
- Subjective Sleep Quality and Ethnicity Are Interactively Related to Standard and Situation-Specific Measures of Pain CatastrophizingPain Medicine, 2011
- Visceral organ cross-sensitization — An integrated perspectiveAutonomic Neuroscience, 2010
- The pathophysiology of endometriosis and adenomyosis: tissue injury and repairArchiv für Gynäkologie, 2009
- Menstrual Symptoms in Adolescent Girls: Association with Smoking, Depressive Symptoms, and AnxietyJournal of Adolescent Health, 2009
- Central Sensitivity Syndromes: A New Paradigm and Group Nosology for Fibromyalgia and Overlapping Conditions, and the Related Issue of Disease versus IllnessSeminars in Arthritis and Rheumatism, 2008
- An internet survey of 2,596 people with fibromyalgiaBMC Musculoskeletal Disorders, 2007
- Diagnosis and management of dysmenorrhoeaBMJ, 2006