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Dysmenorrhea and
Premenstrual Syndrome
Chapter 27
Jacqueline Kohl, MD, MPH
❍ Define primary dysmenorrhea.
Menstrual pain without pelvic pathology.
❍ What percentage of women are affected by dysmenorrhea?
Between 50% and 90% of women, of which 10% may be incapacitated for 1 to 3 days each month. It is the most
common reason women miss work, with 17% of women missing school or work.
❍ What are the risk factors for dysmenorrhea?
Age <30 years, BMI < 20 kg/m^2 , smoking, menarche prior to age 12, longer duration of bleeding, irregular or
heavy bleeding, and prior sexual assault.
❍ What are the protective factors for dysmenorrhea?
Younger age of first birth and higher parity.
❍ What is the cause of primary dysmenorrhea?
Increased endometrial prostaglandin production. Prostaglandin levels increase threefold from the follicular to the
luteal phase and further during menstruation.
❍ In what phase of the endometrium, are these compounds increased?
The secretory endometrium.
❍ The fall of what hormone in the late luteal phase triggers the pathway that increases prostaglandin
production?
Progesterone.
❍ Name the compound that is the substrate for the release of prostaglandin.
Arachidonic acid.