Primary Dysmenorrhea: Assessment and Treatment

Abstract Primary dysmenorrhea is defined asmenstrual pain in the absence of pelvic disease. It is characterized by overproduction of prostaglandins by the endometrium, causing uterine hypercontractility that results in uterine muscle ischemia, hypoxia, and, subsequently, pain. It is the most common gynecological illness in women in their reproductive years and one of the most frequent causes of pelvic pain; however, it is underdiagnosed, undertreated, and even undervalued by women themselves, who accept it as part of themenstrual cycle. It hasmajor implications for quality of life, such as limitation of daily activities and psychological stress, being one of themain causes of school and work absenteeism. Its diagnosis is essentially clinical, based on the clinical history and normal physical examination. It is important to exclude secondary causes of dysmenorrhea. The treatment may have different approaches (pharmacological, nonpharmacological and surgical), but the first line of treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs), and, in cases of women who want contraception, the use of hormonal contraceptives. Alternative treatments, such as topical heat, lifestyle modification, transcutaneous electrical nerve stimulation, dietary supplements, acupuncture, and acupressure, may be an option in cases of conventional treatments’ contraindication. Surgical treatment is only indicated in rare cases of women with severe dysmenorrhea refractory to treatment.摘要 原发性痛经（Primary dysmenorrhea）定义为无盆腔疾病前提下出现的经期疼痛。其特征为子宫内膜前列腺素生成过量，引发子宫过度收缩，进而导致子宫肌缺血、缺氧，最终引发疼痛。该病是生育年龄女性最常见的妇科疾病，也是盆腔疼痛最常见的诱因之一；然而，其诊断不足、治疗不充分的情况十分普遍，甚至不少女性自身也对此不够重视，将其视为经期的正常组成部分。原发性痛经对生活质量存在显著负面影响，可限制日常活动、引发心理压力，是导致学生旷课与职工旷工的主要原因之一。其诊断本质上属于临床诊断，基于病史采集与正常的体格检查结果，需注意排除继发性痛经的病因。治疗方式可分为药物、非药物及手术三类，但一线治疗方案为非甾体抗炎药（NSAIDs）；对于有避孕需求的女性，则可选用激素类避孕药。若患者存在常规治疗的禁忌证，可选择局部热敷、生活方式调整、经皮神经电刺激、膳食补充剂、针灸及穴位按压等替代疗法。仅在极少数经治疗仍无效的重度原发性痛经女性患者中，才考虑手术治疗。