Dysmenorrhea (primary, secondary): symptoms and treatment


What is dysmenorrhea?

Dysmenorrhea, also known as algomenorrhea, menalgia or odinomenorrhea, is a condition characterized by severe menstrual cramps . The word comes from the Greek and means “difficult or painful menstruation”. About 50% to 90% of women have already suffered from this disease at some point during their fertile period .

Menstruation occurs when the female body prepares to produce a baby and there is an increase in progesterone (sexual hormone that acts in the ovulatory cycle and in pregnancy), which makes the endometrium thicker – the wall that lines the inner part of the uterus that provides the development of the fetus.

When fertilization does not happen, the body expels this material from the body, causing bleeding accompanied by fragments of tissue and discarded eggs.

Usually, this process causes abdominal and pelvic pain before or during menstruation, characterizing menstrual cramps. The duration of symptoms is around 24 hours. However, 10% to 15% of women show more intense signs.

In adolescents, the percentage of people affected is 52%, with 10% of them unable to go to work for a period of 1 to 3 days during the menstrual cycle.

The chances of having the problem increase for young women with a history of diseases associated with the onset of secondary dysmenorrhea. The use of the copper Intrauterine Device (IUD) is also responsible for menstrual pain. In addition, some women believe that the use of tampons intensifies the symptoms.

Dysmenorrhea can be found in the International Classification of Diseases (ICD-10) through the codes N94.4 (primary), N94.5 (secondary) N94.6 (unspecified).

Dysmenorrhea and dyspareunia: what is the relationship?

During sexual intercourse, the woman may experience discomfort or pain at the time of penetration, characterizing dyspareunia. When this happens, it is indicative of physical or psychological problems.

Dyspareunia is one of the symptoms of endometriosis , which causes inflammation inside the vagina and that is why pain occurs. Endometriosis, in turn, is a disease related to the onset of secondary dysmenorrhea.


Dysmenorrhea can be categorized as primary or secondary:

Primary dysmenorrhea

Primary dysmenorrhea is a common condition and is related to regular menstruation and normal bleeding. Pathology does not depend on family history. Women between 17 and 25 years old and those without children are the most affected.

Its onset occurs 6 to 12 months after menarche (first menstrual flow, usually in girls aged 12 to 13) and occurs 24 to 48 hours before menstruation and ends successively during the first day of bleeding.

It is caused by the excess of prostaglandin, a substance that has a function similar to that of hormones and that helps in several systems of the organism, but acts only in the cell itself and in the nearest ones. The increase in prostaglandin causes acute pain at intervals in the region below the abdomen.

Secondary dysmenorrhea

Secondary dysmenorrhea is defined by persistent and unbearable pain . It occurs in any period after menarche, alternating its onset and intensity of colic, and may persist throughout menstruation.

Characterized by the regular cycle and menorrhagia (exaggerated increase in menstrual flow), this type of dysmenorrhea is common in women over the age of 30 and in those who have children. In addition, on physical exams, it is possible to find pelvic changes.

It is also related to an increase in the amount of prostaglandin. What differs from the primary, is that the substance operates in conjunction with an organic disease in the pelvic region, that is, disorders in the reproductive system, intensifying pain and inflammation.

Because of this, it is considered an extrinsic or acquired disease, that is, caused by an irregularity in the organism.


Menstrual cramps result from contractions in the uterus, a muscle that is part of the female reproductive system. If this spasm is very intense during the menstrual period, the blood vessels can be compressed, causing the transfer of oxygen to the uterus to stop soon. The absence of oxygen is what creates the pain.

The causes of dysmenorrhea depend on whether it is primary or secondary:


Primary dysmenorrhea usually appears due to the oscillation of some component in the body, with prostaglandin being the most common. Produced from progesterone, the increased level of prostaglandin causes strong spasms in the uterus, which compresses the surrounding blood vessels, making it difficult for oxygen to pass to the uterine tissues, causing abdominal pain.


Secondary dysmenorrhea, in turn, results from changes in prostaglandin in conjunction with medical problems in the reproductive system:


About 6 million Brazilian women in the 30-year-old age group have the disease. Endometriosis causes atypical growth of the endometrium outside the uterus. When not expelled by menstruation, the tissue can travel to the ovaries or the abdominal cavity, resulting in injuries.

Symptoms consist of severe pain and infertility. There is no definite cause, but the chances increase if there is a diagnosis in the mother or sister.


Adenomyosis is a variation of endometriosis, however, in this case, the endometrial enlargement occurs within the uterine musculature. It can be focal (when it is in a specific part of the uterus) or diffuse (when it covers the entire wall of the uterus, making it heavier and fuller).

Usually, the initial symptoms of adenomyosis appear 2 to 3 years after delivery, even in those who have had the condition since childhood. The woman is affected by pain, bleeding and severe cramps. Due to the absence of menstruation after menopause , the problem goes away.

Cervical stenosis

Caused by compression of the internal cervical os, the cervical stenosis can trigger hematometra (blood accumulation in the uterus), pyometra (accumulation of pus in the uterus, especially in women who have cancer cervical and uterine) and delayed menstrual flow in menopausal women, which may result in endometriosis.

Dysmenorrhea is one of the symptoms, in addition to amenorrhea, unusual bleeding and infertility. Dilatation of the uterus and vagina are not ruled out.

Congenital anomalies in the reproductive system

Dysmenorrhea can occur due to physical abnormalities of Organs genitals or perceived through touch.

Ovarian cysts and tumors

Cysts and tumors in the ovaries hinder blood circulation. In addition to menstrual cramps, abnormal vaginal bleeding occurs in some situations. For patients with advanced cancer, indigestion, excess intestinal gas and back pain are also present.

Uterine myoma

Known as uterine leiomyoma, fibroma or fibroid, uterine myoma is a benign tumor that appears both inside and outside the uterus, causing changes in the physiognomy of the organ.

Its origin is unknown, but it is related to progesterone and estrogen. Because of this, it is common for women who entered menopause, between 40 and 50 years of age, to suffer from the problem, since in this period the level of these hormones are lower.

In 75% of the cases of women affected by myoma, half of them do not manifest the symptoms, which consist of irregular menstruation, urinary dysfunctions and abdominal, pelvic and sex pains.

Pelvic inflammation

Pelvic inflammatory disease (PID) is caused by bacteria, such as Chlamydia trachomatis and Gonococo , present in sexually transmitted diseases (STDs), which infiltrate the cervix and cause infection in the reproductive organs.

Transmission is done through sexual contact, abortion or surgical treatment (scaling and vaginal dilation). The woman may experience pain in the lower abdomen, yellowish vaginal discharge and irregular menstruation.

Pelvic congestion syndrome

Pelvic congestion syndrome is a chronic pain (more than six months) in the pelvis – area below the abdomen -, caused by blood clumping in the veins of the pelvis, due to its dilation and curling (varicose veins).

The pain is variable and can be prolonged and imprecise, acute or throbbing. The pain may increase at the end of the day, when the woman is lying down and during or after sexual intercourse. Fatigue , mood swings, headaches and swelling are other symptoms presented.

Polyps in the cervix

The excess of cells in the inner wall of the uterus generates lesions similar to warts , but formed by epithelium. This disorder is known as uterine polyp.

Hormonal changes or infection around endometrial vessels are the main factors for the appearance of the problem. As a consequence, the woman suffers from bleeding outside the menstrual period and with more intense flow.

Copper IUD

The copper intrauterine device (IUD) is a small object inserted into the woman’s uterus. It has a T shape, composed of a copper wire or cylinders, which releases ions, paralyzing the sperm and its locomotion through the uterus.

In rare cases, when the sperm is able to pass through this impediment, the copper IUD also inhibits the fixation of the fertilized egg in the uterine wall. The procedure is valid for 5 to 10 years.

Despite so many benefits, this method is not suitable for women with menstrual flow and severe cramps. The copper IUD has inflammatory substances in its mixture that can worsen the condition.

Risk factors


Menstrual colic is common in women who are in the fertile period, between 12 to 45 years of age. However, it appears between 6 to 12 months after the first menstruation and is more intense at this stage.

This is because young girls still have a small uterus and produce more prostaglandins. Prostaglandins, in turn, increase contractions so that the endometrium can pass through the canal, which results in greater blood flow and more intense pain.

From the complete development of the uterus over the years, there is enough space for the material to be released, relieving symptoms.


The nicotine present in cigarettes causes an obstruction in the blood passage, potentiating the cramps. However, passive smokers (non-smokers who live with smokers indoors) are also prone to develop dysmenorrhea.


Alcohol consumption directly affects the liver’s enzymatic system, which has the function of eliminating toxins from the body and plays an important role in the functioning of hormones, especially during the days before menstruation.

Bad eating habits

Fatty foods, abundant in sugar and caffeine, contribute to the female hormone excess, which increases abdominal pain.


Having a body mass above what is considered healthy intervenes in the production of estrogen – a hormone that has the function of forming the inner wall of the uterus eliminated during menstruation.

The unrestrained increase in estrogen produces a thicker coating, resulting in a bulky flow with marked symptoms.

Not having children

Women who have children naturally have the widest cervix, which facilitates the passage of blood.

Family history

There is no conclusive information on the matter. What is known, however, is that if the mother has dysmenorrhea, the daughter’s chances of triggering the disorder increases 20-fold.

Dysmenorrhea symptoms

In dysmenorrhea, women usually experience pain in the regions below and on the sides of the belly, back, buttocks and vagina. They can occur in two ways: spasmodic (acute and spaced pelvic cramps) or congestive (deep and intense pain).

Regarding the duration and the period, in primary dysmenorrhea the pain may persist for 2 to 3 days before menstruation, while in the secondary, it may appear up to 2 weeks before the menstrual period and last for the entire cycle.

According to the Federal Pharmacy Council (CRF), severe pain is present in 2% to 29% of cases, through colic or continuously. Pains reported outside the menstrual cycle, menorrhagia (heavy bleeding), oligomenorrhea (menstrual intervals longer than 35 days) and intermenstrual bleeding (between one period and another) may be indications of secondary dysmenorrhea.

Also according to the CRF, there are different degrees of pain intensity:

  • 0 (absent pain) : daily activities are not affected;
  • 1 (mild pain) : only in some cases the usual activities are affected and the use of analgesics is necessary;
  • 2 (moderate pain) : day-to-day activities are affected, requiring the use of analgesics to relieve symptoms
  • 3 (severe pain accompanied by headache, fatigue, vomiting and diarrhea) : daily activities are notoriously affected. It is common for women to miss work or school

In addition to pain, the most common symptoms of dysmenorrhea are:

  • Headache (headache);
  • Breast augmentation;
  • Enjoo;
  • Diarrhea;
  • Vomiting;
  • Physical exhaustion;
  • Insomnia or excessive sleep;
  • Nervousness;
  • Fainting;
  • Psychic and behavioral changes.

Several women experience intense pain for a few seconds, called “stitches”, aggravated when they are walking or standing and ameliorated in a state of rest.

Watch for signs such as fever , vaginal discharge with pus and severe pains that appear suddenly or that last longer than normal. In such cases, it is necessary to seek medical help immediately.

How is the diagnosis made?

Physical examination and anamnesis (interview with the health professional) are the means used to diagnose primary dysmenorrhea. If symptoms are severe or persistent and pelvic abnormalities are found, it may be indicative of secondary dysmenorrhea. To exclude this possibility, a detailed clinical evaluation with the gynecologist is necessary .

In addition to assessing the clinical history, the specialist can perform a physical test and / or request laboratory and imaging tests to diagnose the problem.

Physical exam

Vaginal touch is recommended for older teenagers and those who already have an active sex life. Through it can be noticed diseases that cause changes in the uterus.

This exam is done in several steps:

  • Genital examination for rashes (redness, lumps), swelling or discoloration;
  • Examination of the vaginal dome to see if blood or unknown agents are present;
  • Examination of the cervix for infections;
  • Bimanual touch that palpates internal reproductive organs. The degree of sensitivity of the cervical movement, the uterus or the adnexal mass (structures that are next to the uterus) is discovered.

Women with primary dysmenorrhea usually have a favorable diagnosis. Those with endometriosis and secondary dysmenorrhea, in 40% of the cases, present alterations in the physical exam.

Laboratory tests

Laboratory analysis has the function of recognizing or excluding agents that cause secondary dysmenorrhea.


Complete blood count or complete blood count (BCC) is used to indicate infections or neoplastic cells (loss of genetic code and its characteristic function).

Cultures of gonococci and chlamydiae, enzyme immunoassay (EIA) and DNA probe test

Both procedures are intended to detect sexually transmitted diseases (STDs) and pelvic inflammatory disease (PID).

Amount of chorionic gonadotropin (HCG)

Chorionic gonadotropin is a hormone produced in the placenta during pregnancy. The aim is to exclude the possibility of ectopic pregnancy , characterized by fertilization and installation of the egg outside the uterus.

Commonly confused with dysmenorrhea, ectopic pregnancy has different symptoms. The pains are sudden and continuous at a certain point, and can become intensive. Vaginal bleeding does not appear in all cases.

If there is a rupture of ectopic pregnancy, the woman may experience dizziness , weakness, tachycardia (rapid heartbeat) or go into shock (decreased or paralyzed transport of oxygen to the cells).

Erythrocyte sedimentation rate (ESR)

Erythrocyte sedimentation rate (ESR), erythrocyte sedimentation rate or Sedimentation rate (VS), measures the sedimentation level of red blood cells by means of a blood sample in a certain time interval.

Through this process it is possible to diagnose subacute salpingitis, which is the inflammation of one or both uterine tubes.

Urine analysis

Urinalysis is necessary to rule out infection of the urinary system.

Guáiaco Test

In the Guáiaco test, blood is observed in the stool. Through it gastrointestinal bleeding can be identified.

125 cancer antigen test (CA-125)

In this test, the amount in the blood of the CA-125 antigen , present in most cancer cells in the ovary, is evaluated .


The method consists of visualizing certain organs using high frequency ultrasonic waves. In this case, the aim is to detect possible disorders, such as fibroids, endometriosis and cysts in the ovaries.

Hysterosalpingography and hysterosonography

Both procedures consist of the injection of a liquid through the cervix in order to ascertain the appearance of polyps (overgrowth of cells lining the inner uterine part), fibroids and congenital deformities.

Hysteroscopy and laparoscopy

The exams allow the doctor to see the pelvic area. In hysteroscopy , a microcamera is placed through the vagina and cervix; in laparoscopy, the microcamera is inserted through a small cut below the navel.

Is dysmenorrhea curable?

Because it is a natural condition and affects most of the female group, dysmenorrhea has no cure , but it can be alleviated if it receives adequate treatment.

What is the treatment?

The treatment can be carried out in two situations: in the prevention of the disease or in the crisis. In the second case, the intervention must be immediate, aiming to decrease or end the pain. In the case of secondary dysmenorrhea, it is important to identify the cause before starting treatment.

Contraceptive pill

The contraceptive pill is recommended for women who suffer from secondary dysmenorrhea. The drug works by inhibiting the natural hormonal cycle and ovulation. Consequently, the production of prostaglandins happens in a balanced way. In more serious cases, the birth control pill is 80 to 90% efficient.

Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs are indicated for primary dysmenorrhea, as they prevent the formation of excess prostaglandins, reduce abdominal pain and inflammation. The woman should start taking the medication a few hours before or at the beginning of menstrual cramps at intervals of 6 to 8 hours.

Treatment is effective when administered early and in correct amounts. In young women with good physical condition, drugs used for a short period are recommended because they have low levels of toxicity.

However, these medications can cause some side effects, such as gastrointestinal discomfort, and can progress to bleeding and kidney failure.


NSAIDs are contraindicated for people who have hypertension, heart or kidney failure, gastrointestinal disease and asthma .


Hypertensive patients should use paracetamol to reduce symptoms, instead of non-steroidal anti-inflammatory drugs, which can increase blood pressure.

The way in which they worsen the patient’s condition remains unclear, however, what is known is that prostaglandin synthesis is banned and the effectiveness of certain antihypertensive drugs is reduced.

Cardiac insufficiency

NSAIDs aggravate the clinical condition of people with this problem. Paracetamol is also indicated for this category.

Renal insufficiency

Complications from the use of the medication occur in 1% to 5% of cases. Patients with a medical history or who fear they have kidney failure are subject to worsening. Complications include:

  • Hemodynamic changes (blood circulation);
  • Electrolyte imbalances, when the main electrolytes in the human body are not in sufficient quantity to perform their functions;
  • Acute interstitial nephritis – renal inflammation where its attribution is lost;
  • Nephrotic syndrome (excretion of excess protein in the urine);
  • Renal papillary necrosis, that is, a part or all of the renal papillae dies.

Hormonal IUD

The hormonal IUD, also known as medicated IUD, Mirena or IUS , is a uterine contraceptive method. It is applied to the woman’s uterus in order to prevent the passage of sperm to the egg and thus prevent pregnancy.

Unlike copper IUDs, this procedure releases the hormone levonorgestrel (synthetic progesterone) in small amounts daily. Valid for 5 years, it reduces menstrual pain and menstrual flow over time.

However, the use of the hormonal IUD can cause some discomfort and even serious health problems, such as:

  • Cramps;
  • Headaches;
  • Sensitivity,
  • Acne.

In uncommon cases, there may be heavy bleeding, infection at the introduction of the IUD, perforations or the body’s non-acceptance of the method.


Surgery is the last resort in situations of fibroids, endometriosis and cancers, when previous treatment has failed. It can be performed through hysterectomy , laparoscopy for ablation of the uterine nerve (LUNA) or pre-sacral neurectomy (PSN).


Hysterectomy consists of the removal of a part of the uterus or its entirety, which can be done through the abdomen or vagina. Recovery lasts around 3 to 8 weeks.

Laparoscopy for uterine nerve ablation (LUNA)

Laparoscopy for uterine nerve ablation removes nerve fibers and secondary ganglia through the uterosacral ligament in order to relieve pain.

Neurectomia pré-sacral (PSN)

The process of pre-sacral neurectomy is similar to that of LUNA. However, the interruption of nerve fibers happens through the pelvis. Regarding pain, its efficiency is greater compared to laparoscopy.

However, PSN can bring some complications. Among them is: contusion in the urethra, hemorrhage in the middle sacral vein, injury to the bladder and intestine.

Alternative resources

Alternative resources serve as a complement to the treatment prescribed by the doctor:


Acupuncture consists of the introduction of needles, moxa (burning of Artemisia herb) and other instruments, in specific points of the human body, in order to release chemical components that have analgesic and anti-inflammatory activity.

In cases of dysmenorrhea, acupuncture reduces menstrual pain precisely by regulating the dosage of prostaglandin. In addition, it also provides relaxation and calm.


Physical therapy exercises, such as the use of heat, pelvic activities, massages on the back and abdomen, promote the reduction of pain and relaxation of the muscles. In cases of primary dysmenorrhea, symptoms can be stopped.

Home Remedies

Teas are a great way to ease the pain of menstrual cramps, as they relax your muscles and increase blood flow. However, its effectiveness is not proven, and consultation with the gynecologist is recommended before taking any measures.

Oregano tea


  • 2 tablespoons of oregano;
  • 1 cup of water.

Preparation mode

Boil the water and add the oregano and seal the container. Let the contents rest for 5 minutes. It should not be sweetened. Ingest 2 to 3 times a day.

Marigold tea


  • 1 dessert spoon of marigold flowers;
  • 1 cup of water.

Preparation mode

At the boiling point of water, place the marigold flowers and cover. The boiling time is 10 minutes. Then strain the tea. Drink for 10 days before menstruation begins.


The drugs indicated for dysmenorrhea are generally intended for pain relief. The most common are:


  • Mefenamic acid ( Ponstan ),
  • Celecoxibe (Celebra),
  • Cetoprofeno (Bi-Profenid),
  • Diclofenac Cholestyramine ( Flotac ),
  • Potassium Diclofenac ( Fenaflan D , Cataflam Drágeas ),
  • Diclofenac Resinate ( Cataflam Drops ),
  • Diclofenac Sodium ,
  • Etodolaco ( Flancox ),
  • Ibuprofen ( Ibuprofen , Advil , Alivium , Buscofem , Ibupril Capsule , Ibupril Drops ),
  • Sodium Naproxen ( Naprosyn , Aleve),
  • Piroxicam ( Feldene ).


  • Acetylsalicylic acid ( Aspirin ),
  • Paracetamol.


  • Scopolamine Butylbromide ( Buscopan ).

Antispasmodics + pain relievers

  • Papaverine Hydrochloride + Sodium Dipyrone ( Atroveran compound ).

Oral contraceptives

  • Medroxyprogesterone Acetate ( Provera , Depo Provera ),
  • Drospirenona + Ethinylestradiol ( Yasmin , Summer ),
  • Levonorgestrel (Mirena).


NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Living together

Some habits and measures during menstrual cramps can help to alleviate it:


Taking warmer baths, making hot water compresses on the abdomen for a period of 20 minutes, using patches or wraps for 8 to 12 hours together with the medications, helps to relieve pain due to the analgesic action of the local heat.

One of the possible assumptions as to why this happens is that warming increases blood flow, removing substances that cause pain, in addition to reducing pressure and abdominal muscle spasm. In addition, heat also slows pain in the hypothalamus (head region).


One of the functions of prostaglandin is to break down fat cells, so the more fatty foods you eat, the more of that component will be produced. Invest in low-fat foods, including fruits, vegetables, and those rich in vitamins , minerals and fiber, as they aid digestion.

Physical activity

People who practice physical activity tend to experience relief from the symptoms of dysmenorrhea due to reduced release of prostaglandins. The results include relaxation of the pelvis muscles and decreased stress and fatigue.

Walking, swimming and dancing are some examples of aerobic exercises that help to alleviate dysmenorrhea. This is possible through the release of endorphins (a neurotransmitter that provides a feeling of well-being), improvement in blood circulation and greater oxygenation.

However, there is no determination of the time, frequency or intensity of the practices adopted in order to mitigate dysmenorrhea. Before starting your exercise routine, consult your physical education professional.


Drinking a lot of water favors the dispersion of substances that cause menstrual cramps.

Stop smoking

As already mentioned, smoking is one of the risk factors for the onset of dysmenorrhea. A recent study revealed that the condition is associated with increased passive exposure to tobacco. Therefore, knowing the causes, habits of smoking and seeking help are essential to end the addiction.

Transcutaneous electrostimulation of nerves (TENS)

The transcutaneous electrical nerve stimulation (TENS) is used in reducing pain by means of an electric current applied to the region to be treated. The intensity of the electrical voltage varies for each patient, totaling 30 minutes of session.

Among the benefits are the reduction of menstrual pain and ischemia (suspension or decrease in blood supply) of the uterus, in addition to the release of endorphins.

Lying face down on a pillow and massaging the abdominal area also relieve abdominal pain.


Intense pain can affect your routine, disrupting your performance at school, work or in social settings. In addition, dysmenorrhea associated with other diseases can cause complications in:

Pelvic and intestinal canal

In an aggravated state, endometriosis is responsible for the appearance of pelvic and ovarian cysts, internal scarring, blockage of the urethra (a channel that allows urine to pass from the renal pelvis to the bladder), in addition to causing infertility.


Pelvic inflammatory disease (PID) can also cause infertility and damage to the fallopian tubes – which give rise to ectopic pregnancy (when the fertilized egg is outside the uterus).

Who has dysmenorrhea can get pregnant?

In cases of primary dysmenorrhea, pregnancy occurs normally without any impediments. Secondary dysmenorrhea, as it is associated with other diseases, such as endometriosis, which compromise female reproductive organs, makes fertilization difficult.

How to prevent dysmenorrhea?

Dysmenorrhea can be prevented only through reeducation. Healthy habits, such as a good diet, physical exercise, not smoking and not consuming alcoholic beverages, in addition to drinking a lot of water, are effective in combating dysmenorrhea.

Consult your gynecologist regularly and watch for signs of abnormal menstrual cramps.

Dysmenorrhea is a disease that affects most women and causes severe menstrual pain. It may be associated with other pathologies that interfere with the reproductive system.

Share this post and be aware of the symptoms and care needed to prevent it!