Dysmenorrhea
Dysmenorrhea is painful menstruation, characterized by crampy lower-abdominal or pelvic pain occurring before or during menses, often accompanied by back pain, leg pain, nausea, diarrhea, or headache.
Primary dysmenorrhea arises from prostaglandin-mediated myometrial contractions and ischemia in the absence of pelvic pathology. It typically begins within six to twelve months of menarche. Secondary dysmenorrhea stems from identifiable pathology: most commonly endometriosis and adenomyosis, and also uterine fibroids, ovarian cysts, pelvic inflammatory disease, cervical stenosis, or intrauterine devices.
In Restorative Reproductive Medicine, dysmenorrhea is treated as a diagnostic signal of underlying pathology rather than suppressed with combined oral contraceptives. RRM clinicians consider suppressive hormonal medications to be disease-masking, not curative. First-line pain management targets prostaglandin synthesis via NSAIDs. Persistent or severe dysmenorrhea triggers a thorough workup: cycle charting (Creighton Model, FEMM), pelvic ultrasound, and laparoscopy with directed excision of endometriosis when pathology is confirmed. Restorative excision of underlying endometriosis addresses the anatomical source and can resolve long-standing dysmenorrhea.
This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.