Dysmenorrhea: Contemporary Perspectives
- 1 September 2008
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Obstetrical & Gynecological Survey
- Vol. 63 (9), 597-603
- https://doi.org/10.1097/ogx.0b013e31817f15ff
Abstract
Dysmenorrhea affects up to 80% of reproductive age women, in many cases causing sufficient pain to dramatically affect social and occupational roles. The prevalence varies across ethnic groups, which in part may reflect varying cultural attitudes toward women and menstruation. Key identified risk factors for dysmenorrhea include age of menarche, body mass, dietary habits, associated uterine bleeding disorders, comorbid pelvic pathology, and psychosocial problems. While much of the focus on the pathogenesis of dysmenorrhea has focused on aberrant inflammatory mediators in the uterine environment, recent studies using experimental quantitative sensory testing suggest central processing of pain is enhanced in many of these women as well, similar to both irritable bowel syndrome and painful bladder syndrome, which are closely related visceral pain disorders. The mainstays of treatment include nonsteroidal antiinflammatories and combined oral contraceptives; although only the former has extensive level I evidence to support its efficacy. Surgical treatments (presacral neurectomy or uterosacral nerve ablation) appear to be beneficial in a subset of women, but are associated with small, but serious, risks of visceral or vascular injury. Complementary and alternative treatments such as vitamin B1 and magnesium supplementation have not been studied as extensively but show some promise as well. In particular, treatments targeting central aberrations in pain processing, as used in chronic pain management, may prove beneficial as a more multidimensional approach to this common malady is accepted in our field.Keywords
This publication has 37 references indexed in Scilit:
- Surgical interruption of pelvic nerve pathways in dysmenorrhea: a systematic review of effectivenessActa Obstetricia et Gynecologica Scandinavica, 2007
- Primary DysmenorrheaObstetrics & Gynecology, 2006
- The burden and determinants of dysmenorrhoea: a population‐based survey of 2262 women in Goa, IndiaBJOG: An International Journal of Obstetrics and Gynaecology, 2006
- Premenstrual Syndrome, Premenstrual Dysphoric Disorder, and Beyond: A Clinical Primer for PractitionersObstetrics & Gynecology, 2004
- A double‐blind randomised controlled trial of laparoscopic uterine nerve ablation for women with chronic pelvic painBJOG: An International Journal of Obstetrics and Gynaecology, 2004
- Prevalence of menstrual pain in relation to the reproductive life history of women from the Mayan rural communityAnnals of Human Biology, 2004
- Pharmacotherapy of premenstrual syndromes and premenstrual disphoric disorder: current practicesExpert Opinion on Pharmacotherapy, 2002
- Gastrointestinal Toxicity With Celecoxib vs Nonsteroidal Anti-inflammatory Drugs for Osteoarthritis and Rheumatoid ArthritisJAMA, 2000
- Relief of primary Dysmenorrhea by Transcutaneous Electrical nerve StimulationActa Obstetricia et Gynecologica Scandinavica, 1985
- PROSTAGLANDIN E AND F CONCENTRATIONS IN HUMAN ENDOMETRIUM AFTER INSERTION OF INTRAUTERINE CONTRACEPTIVE DEVICEThe Lancet, 1976