Dysmenorrhea is one of the commonest gynecological conditions that affects the quality of life of many women in their reproductive years.   It is experienced as uterine cramps and can occur a few days prior to menstruation and/or during menstruation, and usually subsides at the end of menstruation.
Dysmenorrhea is further defined within 2 subcategories although it is not always easy to distinguish between both subcategories based on history and exam alone:
Primary dysmenorrhea occurs in the absence of pelvic pathology
Secondary dysmenorrhea occurs in the presence of pelvic pathology.
The prevalence is difficult to determine because different definitions and criteria are used, and dysmenorrhea is often underestimated and undertreated.  A systematic review of chronic pelvic pain and dysmenorrhea quotes a prevalence of between 47% to 97%.  A cross-sectional study reported dysmenorrhea in 72% of young women at the age of 19 years, and in 15% of them, it was severe and affected daily activities.  Absenteeism from work or school on a regular basis due to dysmenorrhea can occur in up to 17% of women.  The same study showed that up to 50% of these women were absent from work or school at least on one occasion due to dysmenorrhea, and 7.9% of them were absent during every menstruation for at least half a day.
Factors that correlate positively with dysmenorrhea are smoking, early menarche, nulliparity, and family history.   Dysmenorrhea is not associated with the duration of the menstrual cycle, but it usually coexists with menorrhagia.
Primary dysmenorrhea routinely occurs 6 to 12 months following menarche, once ovulatory cycles have been established. Pain is usually lower abdominal and cramping in nature. Pain may radiate to the back and to the inner thigh. It usually lasts from 8 to 72 hours and accompanies menstrual flow or precedes it by only a few hours. The pain can be associated with other systemic symptoms such as vomiting, nausea, diarrhea, fatigue, and headache. There may also be increased sensitivity to pain. 
Clinical investigations fail to reveal an underlying pelvic pathology.
By contrast, secondary dysmenorrhea often occurs years after the onset of menarche and may arise as a new symptom when the woman is in her 30s or 40s in the setting of an identifiable pelvic disease. The pain is not consistently related to menstruation alone, and may occur throughout the luteal phase of the menstrual cycle. It may also worsen as menses progresses rather than being confined to the first 24 to 48 hours of menstruation. Accompanying symptoms such as an irregular bleeding pattern, heavy periods, vaginal discharge, and dyspareunia can be suggestive of an underlying pelvic pathology. 
Common causes of secondary dysmenorrhea are endometriosis, chronic pelvic inflammatory disease, adenomyosis, intrauterine polyps, submucus fibroids, and intrauterine devices. Less common causes include congenital uterine abnormalities, cervical stenosis, and an ovarian pathology.
Head of Section
Reproductive and Maternal Medicine
University of Glasgow
MAL declares that she has no competing interests.
University of Glasgow
SI declares that she has no competing interests.
Dr Mary Ann Lumsden and Dr Stamatina Iliodromiti would like to gratefully acknowledge Dr Suketu M. Mansuria and Dr Linda C. Lang, the previous contributors to this monograph. SMM and LCL declare that they have no competing interests.
Ob/Gyn and Urology
Division of Urogynecology
Associate Residency Program Director
Temple University Hospital
VD declares that he has no competing interests.
Reproductive Endocrinology & Infertility Department
Baptist Medical Center
Odessa Reproductive Medicine
MM declares that he has no competing interests.
Professor and Chair
Department of Neurology
Wake Forest University School of Medicine
RS declares that he has no competing interests.
Peel Health Campus
PR declares that he has no competing interests.
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