Dysmenorrhea is one of the most common gynaecological problems in women. It is the medical term for the painful cramps that may occur immediately before or during the menstrual period. Dysmenorrhea is divided into primary dysmenorrhea and secondary dysmenorrhea.

The Primary dysmenorrhea is idiopathic (of unknown cause) and it is associated with camp-like abdominal pain at the time of menstruation with no identifiable organic pelvic disease. Cramps mostly usually begin about one to two years after a woman starts getting her period which can be mild or even sometimes severe. Common menstrual cramps often start shortly before or at the beginning of the period and continues for about one to three days. This cramp becomes less painful as a woman ages and may disappear after a woman's first baby.
The Secondary dysmenorrhea is usaually associated with pelvic pahology (disorder or disease of the female reproductive organ).
Etiology/pathophysiology of Primary Dysmenorrhea

The cause of primary dysmenorrhea is not fully known, but it is known to be related to increase in prostaglandin levels. The prostaglandins stimulate uterine contractions and cervical narrowing and release vasopressin (a hormone that constricts blood vessel). Leukotrienes (inflammatory mediator known to cause vasoconstriction and uterine contraction) are also released. The increased level of these hormone and inflammatory mediator result in uterine ischemia and pain.

During normal menses, contaction pressure is about 50-80mmhg and each contraction lasts about 15-30 seconds and 1-4 contractions in every 10minutes. these normal contractions help to expel menstrual fluids. With Dysmenorrhea, however, contraction pressure can exceed 400mmhg and may last longer than 90seconds and the time between contractions may be less than 15seconds. Both intrauterine pressure and the frequency of uterine contractions contribute to ischemia and tissue hpoxia and thus, to pain.
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