Primary Dysmenorrhea: An Urgent Mandate

ysmenorrhea, defined as pain associated with men- struation, is subclassified as either primary, in the absence of underlying organic disease, or secondary to a specific abnormal - ity. Potential causal abnormalities for secondary dysmenorrhea include en- dometriosis (and adenomyosis), uterine fibroids (myomas), congenital uterine anomalies, endometrial polyps, use of an intrauterine contraceptive device, ectopic pregnancy, pelvic adhesions, pelvic abscess, pelvic inflammatory dis - ease, ovarian cysts, ectopic pregnancy, and, rarely, uterine or ovarian neo- plasm. 1-3 Although the most common and treatment of endometriosis can therefore be considered relevant to much of the discussion in this issue of Pain: Clinical Updates, which focuses on primary dysmenorrhea. Primary dysmenorrhea usually begins six to 12 months after menarche and is characterized by spasmodic cramping pain in the lower abdomen that can radiate to the lower back and anterior or inner thighs. The pain usu- ally has a clear temporal pattern: it be- gins a few hours before or at the start of menstruation, is most intense at on- set, gradually waning over two to three days, and is sometimes accompanied by nausea, vomiting, and diarrhea, as worldwide report suffering from it, with 10-20% of them describing their suffering as severe and distressing. 7-10