Clinical Review

Diagnosis and management of dysmenorrhoea

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7550.1134 (Published 11 May 2006) Cite this as: BMJ 2006;332:1134
  1. Michelle Proctor, editor (michelle.proctor@woosh.co.nz)1,
  2. Cynthia Farquhar, postgraduate professor in obstetrics and gynaecology2
  1. 1 Cochrane Menstrual Disorders and Subfertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Private Bag 92019, Auckland, New Zealand
  2. 2 Department of Obstetrics and Gynaecology, National Women's Hospital, University of Auckland
  1. Correspondence to: M Proctor

    Introduction

    The prevalence of dysmenorrhoea (painful menstrual cramps of uterine origin) is difficult to determine because of different definitions of the condition—prevalence estimates vary from 45% to 95%. However, dysmenorrhoea seems to be the most common gynaecological condition in women regardless of age and nationality.1 2 Absenteeism from work and school as a result of dysmenorrhoea is common (13% to 51% women have been absent at least once and 5% to 14% are often absent owing to the severity of symptoms).3 Dysmenorrhoea, especially when it is severe, is associated with a restriction of activity and absence from school or work. Yet despite this substantial effect on their quality of life and general wellbeing, few women with dysmenorrhoea seek treatment as they believe it would not help.w1

    Sources and selection criteria

    We used Medline (1966 to March 2006) to conduct a literature search of the Cochrane Database of Systematic Reviews on the Cochrane Library, issue 1, 2006, and we searched citation lists of relevant publications, including studies for randomised controlled trials (RCTs) and review articles. We used the following subject headings and keywords: dysmenorrhoea, dysmenorrhea, menstrual pain, period pain, and pelvic pain.

    What types of dysmenorrhoea are there?

    Dysmenorrhoea is commonly divided into two categories based on pathophysiology (table). Primary dysmenorrhoea is menstrual pain without organic disease, and secondary dysmenorrhoea is menstrual pain associated with an identifiable disease. Common causes of secondary dysmenorrhoea include endometriosis, fibroids (myomas), adenomyosis, endometrial polyps, pelvic inflammatory disease, and the use of an intrauterine contraceptive device.

    View this table:

    Differential diagnosis of primary and secondary dysmenorrhoea

    What causes dysmenorrhoea?

    Until recently, many medical and gynaecological texts ascribed the source of dysmenorrhoea to emotional or psychological problems—for example, anxiety, emotional instability, a faulty outlook on sex and menstruation, and imitation of the mother's feelings about menstruation.w2 However, experimental and clinical research has identified a physiological reason for dysmenorrhoea—the production of …

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