Primary dysmenorrhea is menstrual pain with no underlying medical cause. Secondary dysmenorrhea is menstrual pain that results from structural abnormalities or medical conditions of the reproductive system.
Dysmenorrhea (pain during periods) is a common problem that can affect those who menstruate. A person who has period pain due to primary dysmenorrhea may be able to treat the symptoms with over-the-counter (OTC) pain medication.
However, if a person is having menstrual pain that OTC medications do not relieve, it is essential to contact a doctor to check for causes of secondary dysmenorrhea.
The key difference between primary and secondary dysmenorrhea is in the root cause.
Primary dysmenorrhea is menstrual pain due to natural contraction of the uterus during menstruation.
Secondary dysmenorrhea results from a structural problem with the reproductive organs in the pelvic area or from a medical condition such as endometriosis, uterine fibroids, or pelvic inflammatory disease (PID).
The distinction between the two is important because the two types require different treatment approaches.
Here is a breakdown of the causes of primary and secondary dysmenorrhea.
Primary dysmenorrhea
Period pain is the most common menstrual symptom. An estimated 50% to 90% of people who menstruate experience primary dysmenorrhea.
While there is still more to learn, a 2022 research review suggests that the pain may stem from the overproduction of prostaglandins. These are hormone-like substances that trigger uterine contraction to shed the inner uterine lining during menstruation.
Elevated prostaglandin levels may cause more intense and more frequent contractions, leading to cramping and pain.
- long or heavy periods
- smoking
- early onset of menstruation
- high levels of stress
Secondary dysmenorrhea
Secondary dysmenorrhea happens because of an underlying medical condition or a structural problem with the reproductive organs.
According to the American College of Obstetricians and Gynecologists, the most common cause is endometriosis, a condition in which tissue similar to the inner lining of the uterus grows outside the uterus.
At least two-thirds of adolescents who have dysmenorrhea that does not respond to treatment will receive an endometriosis diagnosis during a laparoscopic exam.
- Uterine fibroids: noncancerous growths in the uterus
- Ovarian cysts: fluid-filled sacs on the ovaries
- PID: an infection of the reproductive organs
- Pelvic adhesions: scar tissue that binds organs together
- Congenital uterine anomalies: structural abnormalities of the uterus or vaginal canal that are present from birth
- Intrauterine devices (IUDs): particularly copper IUDs
Read on to learn the symptoms of primary and secondary dysmenorrhea.
Primary dysmenorrhea
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Additional symptoms can include:
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Secondary dysmenorrhea
While the symptoms of secondary dysmenorrhea are similar to those of primary dysmenorrhea, they may last longer, may not respond to typical treatments, and may be present outside of a person’s typical monthly menstrual period.
A person with secondary dysmenorrhea may also experience pelvic pain at other times, such as during intercourse, during bowel movements, or during urination.
Other symptoms may include:
Learn how healthcare professionals diagnose primary and secondary dysmenorrhea.
Primary dysmenorrhea
Diagnosing primary dysmenorrhea
The healthcare professional will ask questions about a person’s:
- menstrual history
- age at the time of the first period
- menstrual cycle characteristics
- associated symptoms
- previous treatments
- sexual history
It is important to rule out any underlying medical condition that could be causing the pain and discomfort.
Secondary dysmenorrhea
Diagnosing secondary dysmenorrhea involves a more comprehensive approach.
If initial treatments for dysmenorrhea fail or if symptoms suggest an underlying cause, healthcare professionals may perform further evaluation, such as:
Read on to learn treatment options for primary and secondary dysmenorrhea.
Primary dysmenorrhea
Treating primary dysmenorrhea typically involves both pharmacological and non-pharmacological approaches.
The first lines of treatment are nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and hormonal birth control drugs. While these medications typically reduce pain associated with primary dysmenorrhea, some alternative therapies may also help, such as:
In
Secondary dysmenorrhea
The appropriate treatment for secondary dysmenorrhea depends on the underlying cause.
Endometriosis treatment requires multiple approaches aimed at relieving symptoms, slowing progression, and preserving fertility.
Treatments for endometriosis may include:
- hormonal management
- laparoscopic surgery
- pain management with NSAIDs
- stress management
- regular exercise
- a balanced diet
Congenital abnormalities that cause secondary dysmenorrhea may require surgical treatment.
Antibiotics may treat pelvic infections, depending on the underlying pathogen.
Although period pain is common, people do not have to live in discomfort. The notion that period pain is normal, natural, and unavoidable may make it
Anyone who is experiencing period pain should contact a doctor for an evaluation.
It is especially important to contact a doctor if the pain is severe, if OTC pain relievers do not provide enough relief, or if the pain frequently disrupts daily activities.
Heavy menstrual flow with larger clots and atypical pain that is beyond a person’s usual level of discomfort are also reasons to seek a medical assessment.
People with a diagnosis of secondary dysmenorrhea need to contact a doctor if they start experiencing symptoms that differ from their typical symptoms, such as increased pain or bleeding, or if treatments do not reduce their symptoms.
Healthcare professionals
It is crucial for a person to remember that they are their own best advocate. If they feel their pain is not “normal” and it is affecting their quality of life, they should feel empowered to seek a second opinion.
To prepare for appointments, it can be helpful to keep a detailed symptom diary for several months, noting the frequency, severity, and duration of pain and other symptoms.
If a healthcare professional decides not to further investigate pain or other symptoms, a person can ask them to document this decision in the person’s medical record.
A person may also find it valuable to bring a trusted friend or family member to their appointments to provide support and another perspective.
What is the difference between primary amenorrhea and primary dysmenorrhea?
Primary amenorrhea is the absence of a period, whereas primary dysmenorrhea is pain during periods that does not result from an underlying medical condition.
What is the difference between primary dysmenorrhea and PMS?
Primary dysmenorrhea is painful cramping during periods, whereas premenstrual syndrome (PMS) is a wide range of physical and emotional symptoms that can occur in the days leading up to menstruation.
Primary dysmenorrhea is painful menstrual cramping that occurs without an underlying cause. Secondary dysmenorrhea is painful cramping that occurs during menstruation and at other times as a result of an underlying medical condition.
Endometriosis is the most common cause of secondary dysmenorrhea and may require treatments such as hormonal therapy, laparoscopic surgery, and pain management.
It is crucial for people to have open communication with their doctors about their menstrual pain, especially if the pain interferes with their daily activities. If necessary, it is appropriate for a person to seek a second opinion to get to the root cause of their pain.
