Dysmenorrhea refers to pain that is related to menstruation. ICD-10 N94.4N94.6.

There are two types of dysmenorrhea, primary and secondary.

Primary dysmenorrhea does not involve evidence of pelvis disease.
Secondary dysmenorrhea is associated with a disease such as pelvic inflammatory
disease. Typical pain is caused by contractions that are induced
by prostaglandins from the endometrium. As stated by Neinstein, Gordon, Katzman,
Rosen & Woods, 2009, p. 460, "Dysmenorrhea is the greatest single cause of lost
work and school hours in females, with >140 million hours lost per year".

For a patient that is experiencing dysmenorrhea, a history and physical would be

completed as well as possible lab work. When obtaining a history from an
adolescent, it is important that they are asked about the degree of pain they
experience during menstruation as well as if the pain interferes with their activities
of daily living and daily routines. Their previous use of pain relieving methods
should be obtained with the effectiveness of each. Anyone that may be sexually
active should be asked about any history of sexually transmitted diseases. Upon
the physical assessment, a complete review of systems will be conducted as well.
With dysmenorrhea, local symptoms include spasmodic pain in the lower abdomen
that may radiate to the back and thighs, nausea, fatigue, mood changes and
headache.

Differential diagnosis: Gynecologic causes can include pelvic inflammatory

disease, endometriosis and other anatomic abnormalities. Nongynecologic causes
can include gastrointestinal disorders, genitourinary abnormalties and
gastrointestinal disorders such as irritable bowel syndrome.
"Many teenagers with severe cramps suffer for years before they seek treatment
because they think painful periods are just part of growing up" (Sayre, 2008).
The two most effective treatments of dysmenorrhea are nonsteriodal antiinflammatory medications and oral contraceptives. It is said that approximately
80% of individuals pain is relieved by nonsteroidal anti-inflammatories and
approximately 90% of individuals pain is controlled with oral contraceptives.
Non pharmacologic therapies can include exercise and heat application.
If evaluation of the patient shows that there is no nongynecological cause of the
symptoms and treatment of the pain is not successful, then the patient may be
considered for further testing such as laprascopy.