Dysmenorrhea occurs in approximately 35 per cent of menstruating women.1 Primary dysmenorrhea is characterized by painful menstruation in the absence of demonstrable pelvic disease and is thus differentiated from secondary dysmenorrhea.
Primary dysmenorrhea commences with the menarche in 65 per cent2 and a few years later in 35 per cent. Anovulatory cycles have been suggested as the basis for the early painless periods in the later group. The distress starts with the menstrual flow and consists of lower abdominal cramps which may or may not be associated with backache, headache, nausea and vomiting. It persists through one or two days of the flow. The woman with primary dysmenorrhea may complain of prodromal irritability, backache, headache and gastrointestinal upsets. The dysmenorrhea ordinarily disappears, or is considerably relieved, after the birth of the first child. After the age of 30 in the nulliparous woman the dysmenorrhea becomes irregular and of
RANDALL JH, ODELL LD. PRIMARY DYSMENORRHEA. JAMA. 1943;123(12):735–737. doi:10.1001/jama.1943.02840470001001
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