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CC BY 4.0 · Rev Bras Ginecol Obstet 2020; 42(08): 501-507
DOI: 10.1055/s-0040-1712131
Review Article

Primary Dysmenorrhea: Assessment and Treatment

Dismenorreia primária: Avaliação e tratamento
Inês Guimarães 
1   Faculty of Medicine, Universidade do Porto, Porto, Portugal
,
Ana Margarida Póvoa 
1   Faculty of Medicine, Universidade do Porto, Porto, Portugal
2   Department of Gynecology, Unit of Reproductive Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
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Abstract

Primary dysmenorrhea is defined as menstrual 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 the menstrual cycle. It has major implications for quality of life, such as limitation of daily activities and psychological stress, being one of the main 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, non-pharmacological 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.

Resumo

Dismenorreia primária é definida como dor menstrual na ausência de patologia pélvica. Caracteriza-se pelo excesso de produção de prostaglandinas pelo endométrio que provocam hipercontractilidade uterina, resultando em isquemia e hipoxia do músculo uterino e, subsequentemente, dor. É a patologia ginecológica mais comum em mulheres em idade fértil e uma das causas mais frequentes de dor pélvica; contudo, é subdiagnosticada, subtratada, e até desvalorizada pelas próprias mulheres, que a aceitam como parte do ciclo menstrual. A dismenorreia tem grandes implicações na qualidade de vida, como limitação das atividades diárias e estresse psicológico, sendo uma das principais causas de absentismo escolar e laboral. O seu diagnóstico é essencialmente clínico, baseando-se na história clínica e num exame físico sem alterações. É importante excluir causas secundárias de dismenorreia. O tratamento pode ter diferentes abordagens (farmacológica, não farmacológica e cirúrgica), sendo que a primeira linha de tratamento consiste na utilização de anti-inflamatórios não esteroides (AINEs) e, em casos de mulheres que desejem contracepção, no uso de anticoncepcionais hormonais. Tratamentos alternativos, como a utilização de calor tópico, modificação do estilo de vida, estimulação elétrica nervosa transcutânea, suplementos alimentares, acupuntura e acupressão, podem ser uma opção nos casos de contraindicação da utilização dos tratamentos convencionais. O tratamento cirúrgico apenas se encontra indicado em casos raros de mulheres com dismenorreia grave e refratária aos tratamentos.

Keywords

dysmenorrhea - menstrual cycle - pain - NSAIDs - hormonal contraception

Palavras-chave

dismenorreia - ciclo menstrual - dor - AINEs - contracepção hormonal


Publication History

Received: 09 December 2019

Accepted: 23 March 2020

Article published online:
19 June 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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