Management of Primary Dysmenorrhea and Related Symptoms
Summary
Primary dysmenorrhea is characterised by cyclical uterine pain in the absence of pelvic pathology and is driven predominantly by elevated prostaglandin synthesis and enhanced uterine contractility. Affected individuals commonly experience cramping lower abdominal pain accompanied by systemic symptoms such as headache, nausea and fatigue. The condition exerts a substantial impact on quality of life, leading to work or educational absenteeism and psychological distress. Management strategies span pharmacological and non-pharmacological domains. First-line pharmacotherapy employs nonsteroidal anti-inflammatory drugs (NSAIDs) to inhibit prostaglandin production, with combined oral contraceptives or progestins offered to those seeking menstrual regulation or concurrent contraception. Non-pharmacological approaches include the application of localized heat, lifestyle modification encompassing regular physical activity and stress management, transcutaneous electrical nerve stimulation (TENS), dietary supplements and acupuncture. Emerging paradigms harness digital health technologies and personalised regimens to optimise symptom tracking and treatment adherence, thereby advancing a holistic, patient-centred framework for alleviating menstrual pain.
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Technical terms
Primary dysmenorrhea: Menstrual pain without identifiable pelvic pathology, driven by uterine prostaglandin release and hypercontractility.
Prostaglandins: Lipid compounds synthesised in the endometrium that promote uterine contractions and mediate inflammatory pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs): A class of medications that inhibit cyclooxygenase enzymes to reduce prostaglandin synthesis and relieve pain.
Uterine contractility: The strength and frequency of uterine muscle contractions, which when excessive can lead to ischaemic pain.
Transcutaneous electrical nerve stimulation (TENS): A non-invasive therapy delivering low-voltage electrical currents to modulate pain signal transmission.
Hormonal contraceptives: Medications containing oestrogen and/or progestin used to suppress ovulation and stabilise endometrial prostaglandin production.
Self-care strategies: Individual-driven interventions, both pharmaceutical and non-pharmaceutical, for managing symptoms without direct medical supervision.
References
- Feasibility Study on Menstrual Cycles With Fitbit Device (FEMFIT): Prospective Observational Cohort Study. JMIR mHealth and uHealth (2024).
- Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences (2010).
- Dysmenorrhea and related disorders. F1000Research (2017).
- Inflammatory Markers in Dysmenorrhea and Therapeutic Options. International Journal of Environmental Research and Public Health (2020).
- Self-care strategies and sources of knowledge on menstruation in 12,526 young women with dysmenorrhea: A systematic review and meta-analysis. PLOS ONE (2019).
- Primary Dysmenorrhea: Assessment and Treatment. Revista Brasileira de Ginecologia e Obstetrícia (2020).
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