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JAMA Insights
Women's Health
December 19, 2019

Diagnosis and Management of Primary Dysmenorrhea

Author Affiliations
  • 1Division of Gynecology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
JAMA. 2020;323(3):268-269. doi:10.1001/jama.2019.16921

Primary dysmenorrhea is defined as painful menstruation in the absence of pelvic pathology. Characterized by recurrent, crampy, lower abdominal pain during menstruation, it is the most common reason for gynecologic visits, affecting 50% to 90% of women, half of whom describe their pain as moderate to severe.1 Secondary dysmenorrhea refers to the same clinical features of pain during menstruation, but is attributable to pelvic pathology, such as endometriosis, fibroids, adenomyosis, and congenital anatomic abnormalities. Management of primary dysmenorrhea is directed toward excluding other causes of symptoms and identifying medical therapies that control the patient’s symptoms. Despite its high prevalence, dysmenorrhea is often underdiagnosed, inadequately treated, and normalized even by patients themselves, who may accept the symptoms as an inevitable response to menstruation.