Disease Description (Causes and Symptoms)
- Disease name: Primary dysmenorrhea (Primary dysmenorrhea)
- Cause/pathophysiology: Increased prostaglandin production in the endometrium causes strong uterine contractions and ischemia, resulting in pain. This refers to cases without structural lesions in the pelvis. It usually begins within 1–2 years after menarche and is common in young women.
- Main symptoms: Lower abdominal pain occurring several hours before or just after menstruation begins (mainly in the area above the bladder), lower back pain, pelvic tenderness, and radiating pain (to the thighs and sacrum). Associated symptoms include nausea, vomiting, diarrhea, and headache. The pain usually lasts 48–72 hours.
Treatment Methods
- First-line drug treatment
- Nonsteroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen, etc. — Take just before or immediately after the onset of pain, and administer at 6–8-hour intervals for several days. Significant effects are seen in approximately 80% of cases.
- Caution: Use with caution or contraindication applies if there is a history of gastric or duodenal ulcers, aspirin hypersensitivity, or similar conditions.
- Hormonal treatment
- Oral contraceptives (combined oral contraceptives) or progestin-only treatments (such as Mirena): Suppression of ovulation or changes in the endometrium reduce prostaglandin production → relieving menstrual pain. Long-term effects are expected.
- Adjunctive and alternative therapies
- Some symptom relief has been reported with heat therapy (applying a warm compress to the abdomen), regular aerobic exercise, weight management, stress management, relaxation therapy/yoga, acupuncture, aromatherapy, meditation, and others.
- If refractory or suspected
- If symptoms are not controlled with medication or atypical symptoms are present (pain outside menstruation, dyspareunia, irregular heavy bleeding, infertility, etc.), a pelvic ultrasound and, if necessary, diagnostic laparoscopy may be used to identify secondary causes (endometriosis, uterine fibroids, adenomyosis, etc.).
- In cases of severe pain
- Short-term opioid analgesics (e.g., codeine) may be considered, but the risk of misuse, side effects, and psychological factors should be assessed.
- Precautions during treatment
- When administering NSAIDs, monitor for gastrointestinal problems (nausea, indigestion, bleeding, etc.); for hormonal treatment, check for contraindications and side effects (risk of thrombosis, weight changes, etc.). Consult a doctor if you are planning a pregnancy.
Outpatient Visit Checklist (Including Example Questions)
- Items/documents to prepare
- A list of medications currently being taken (prescription drugs, OTC medications, and supplements)
- Menstrual history records: the start date of menstruation, duration, amount of bleeding, time pain starts and subsides, pain intensity (e.g., 0–10), and the timing and effectiveness of pain medication use
- Results of previous gynecological examinations, ultrasounds, and laparoscopies (if available)
- Obstetric history, sexual history, contraception method, and history of chronic diseases (gastric ulcers, thrombosis, etc.)
- Items useful for explaining symptoms to the doctor during the visit
- Timing of pain (before menstruation/immediately after it begins), duration, nature of pain (cramping or continuous), and associated symptoms (nausea, fever, abnormal bleeding)
- Whether medication was effective and whether side effects occurred
Examples of General Questions to Ask the Doctor
- "What are the main side effects of this medication, and what precautions should I take?"
- "When can I expect the pain to improve after starting treatment?"
- "Is it safe for me to start hormonal treatment (such as birth control pills)? What are the risks of long-term use?"
- "How can I determine with certainty whether my symptoms are primary or secondary?"
- "What can I do in terms of lifestyle to reduce the pain?"
Examples of Condition-Specific Questions
- "If NSAIDs do not relieve my pain, what would you recommend as the next step (which tests or treatments)?"
- "If I start a combined oral contraceptive, when can I expect my menstrual pain to decrease, and what effect would stopping it have if I am planning a pregnancy?"
Additional guidance: If severe pain suddenly worsens, or if you have a high fever, persistent pelvic pain outside menstruation, abnormal vaginal bleeding, or symptoms suggesting pregnancy, visit a medical institution immediately.