Primary Dysmenorrhea: Symptoms, Diagnosis, and Treatment Options

Primary dysmenorrhea

Hello Doctor: I would like to inquire if my condition qualifies as primary dysmenorrhea.
I started my menstruation around the age of 12, and from then until I was 22, I experienced lower back pain and a feeling of bloating during my periods, which were bearable.
However, between the ages of 22 and 25, the dysmenorrhea became severe; almost every month on the second day of my period, I would wake up in pain.
Initially, it felt like cramping, followed by weakness, fainting, and excessive sweating.
I visited four hospitals for examinations.
The first hospital performed an ultrasound and the doctor said everything was normal, prescribing painkillers, which alleviated my discomfort during menstruation.
The second hospital treated me for fainting due to dysmenorrhea, and the doctor noted slight endometriosis.
The third hospital reported a mild retroverted uterus.
Recently, at a new hospital, the doctor did not perform an ultrasound and directly prescribed a 14-day contraceptive pill.
After taking the medication, I experienced no discomfort during my period.
Upon follow-up, the doctor prescribed two more months of a different contraceptive pill along with painkillers, and during this time, I experienced bloating on the first and second days of my period.
In April of this year, I underwent an ultrasound, Pap smear, and transvaginal ultrasound, all of which returned normal results.
I would like to ask if my condition can be classified as primary dysmenorrhea.
Thank you for your clarification.

K, 20~29 year old female. Ask Date: 2015/12/24

Dr. Lin Wenbin reply Obstetrics and Gynecology

Have you had a blood test to check your CA-125 levels? Based on your description, the likelihood of primary dysmenorrhea is very high, but other issues cannot be ruled out.

Reply Date: 2015/12/24

More Info

Primary dysmenorrhea is a common condition characterized by painful menstrual cramps that occur in the absence of any identifiable pelvic pathology. It typically begins shortly after menarche and can persist throughout a woman's reproductive years. The pain is usually caused by the release of prostaglandins, which are chemicals in the body that cause the uterus to contract. This contraction can lead to symptoms such as cramping, lower back pain, and sometimes systemic symptoms like nausea and fatigue.

Based on your description, it appears that you have experienced symptoms consistent with primary dysmenorrhea. You mentioned that your menstrual pain began around the age of 12 and became significantly more severe between the ages of 22 and 25. The fact that you experienced debilitating pain that caused you to wake up at night and resulted in faintness and sweating suggests that your dysmenorrhea may have been quite severe during that period.

Your medical evaluations, including ultrasounds and gynecological examinations, have ruled out secondary causes of dysmenorrhea, such as endometriosis or fibroids, which is a positive sign. The mention of "a little bit of endometriosis" from one of the doctors could indicate that there was some concern, but it seems that the overall findings from your recent tests have been normal. The fact that you have found relief with hormonal contraceptives, such as the birth control pills prescribed by your doctor, further supports the diagnosis of primary dysmenorrhea. Hormonal treatments can help regulate the menstrual cycle and reduce the severity of symptoms by decreasing the production of prostaglandins.

In terms of treatment options, primary dysmenorrhea is often managed with nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, which can help alleviate pain by reducing prostaglandin production. Hormonal contraceptives, as you have experienced, can also be effective in managing symptoms. Other options may include lifestyle modifications, such as regular exercise, heat application (like heating pads), and dietary changes.

Since you have experienced some relief with the hormonal treatment, it may be beneficial to continue this approach under the guidance of your healthcare provider. If your symptoms persist or worsen, or if you develop new symptoms, it would be prudent to follow up with your gynecologist for further evaluation.

In summary, your symptoms and medical history suggest that you likely have primary dysmenorrhea, especially given the normal findings on imaging and the relief provided by hormonal treatment. It is essential to maintain open communication with your healthcare provider to ensure that your treatment plan remains effective and to address any concerns you may have about your menstrual health.

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