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14-September-2008 18:02:36 - Dysmenorrhea Redirected from Dysmenorrhoea March 2008 Dysmenorrhea Classification and external resources ICD-10 N94.4-N94.6 ICD-9 625.3 DiseasesDB 10634 MedlinePlus 003150 MeSH D004412 Dysmenorrhea or dysmenorrhoea is a medical condition characterized by severe uterine pain during menstruation. While many individuals experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or require medication. Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia. Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these are detected. Contents 1 Primary dysmenorrhea 1.1 Explanation 1.2 Signs and symptoms 1.3 Etiology 1.4 Pathophysiology 1.5 Diagnosis 1.6 Treatments 1.6.1 Nutritional 1.6.2 NSAIDs 1.6.3 Hormonal contraceptives 1.6.4 Non-drug therapies 1.6.5 Other medications and herbal therapies 1.6.6 Hormonal treatments 1.7 Prognosis 1.8 Epidemiology 2 Secondary dysmenorrhea 3 References 4 External links Primary dysmenorrhea Explanation During a woman's menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is thus not needed. Molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions are responsible for the varying degrees of pain and discomfort commonly experienced during menstruation. Signs and symptoms This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. June 2008 The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thighs and lower back. Other symptoms may include nausea and vomiting, diarrhea, headache, fainting, and fatigue. Symptoms of dysmenorrhea usually begin a few hours before the start of menstruation, and may continue for a few days. Etiology In a systematic review, an age of less than 30 years, a low body mass index, smoking, earlier menarche 12 years, longer menstrual cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilization, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhea.1 Pathophysiology Prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents.2 Release of prostaglandins and other inflammatory mediators in the uterus is thought to be a major factor in primary dysmenorrhea.3 Females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.4 Diagnosis In one research study using MRI, visible features of the uterus were compared in dysmenorrheic and eumenorrheic normal participants. The study concluded that in dysmenorrheic patients, visible features on cycle days 1-3 correlated with the degree of pain, and differed significantly from the control group.5 Treatments Nutritional Several nutritional supplements have been indicated as effective in treating dysmenorrhea, including omega-3 fatty acids, magnesium, vitamin E, zinc, and thiamine vitamin B1. Research indicates that one mechanism underlying dysmenorrhea is a disturbed balance between antiinflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor eicosanoids derived from omega-6 fatty acids.6 Several studies have indicated that intake of omega-3 fatty acids can reverse the symptoms of dysmenorrhea, by decreasing the amount of omega-6 FA in cell membranes.7 89 The richest dietary source of omega-3 fatty acids is found in flax oil.10 Oral intake of magnesium has also been indicated in providing relief: two double-blind, placebo-controlled studies demonstrated a positive therapeutic effect of magnesium on dysmenorrhea.11 12 A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss.13 A review of case histories indicated that zinc, in 1 to 3 30-milligram doses given daily for one to four days prior to onset of menses, prevents essentially all to all warning of menses and all menstrual cramping.14 Intake of thiamine vitamin B1 was demonstrated to provide curative relief in 87% of females experiencing dysmenorrhea, in a controlled study.15 NSAIDs Non-steroidal anti-inflammatory drugs NSAIDs are effective in relieving the pain of primary dysmenorrhea.16 NSAIDs can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.17 Patients who cannot take the more common NSAIDs, or for whom they are not effective, may be prescribed a COX-2 inhibitor.18 One study indicated that conventional therapy with NSAIDs provides symptomatic relief but has increasing adverse effects with long-term use,19 another indicated that long-term use of NSAIDs has severe adverse effects.20 Hormonal contraceptives Although use of hormonal contraception can improve or relieve symptoms of primary dysmenorrhea,2122 a 2001 systematic review found that no conclusions can be made about the efficacy of commonly used modern lower dose combined oral contraceptive pills for primary dysmenorrhea.23 Norplant24 and Depo-provera2526 are also effective, since these methods often induce amenorrhea. The IntraUterine System Mirena IUD has been cited as useful in reducing symptoms of dysmenorrhea.27 Non-drug therapies Several non-drug therapies for dysmenorrhea have been studied, including behavioral, acupuncture, acupressure, chiropractic care, and the use of a TENS unit. Behavioral therapies assume that the physiological process underlying dysmenorrhea is influenced by environmental and psychological factors, and that dysmenorrhea can be effectively treated by physical and cognitive procedures that focus on coping strategies for the symptoms rather than on changes to the underlying processes. A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.28 Acupuncture and acupressure are used to treat dysmenorrhea. A review cited four studies, two of which were patient-blind, indicating that acupuncture and acupressure were effective.29 This review stated that the treatments appear promising for dysmenorrhea, and that the researchers considered further studies to be justified. Another study indicated that acupuncture reduced the subjective perception of dysmenorrhea,30 still another indicated that adding acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life.31 Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms,32 a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.33 Treatment with a transcutaneous electrical nerve stimulation TENS unit, often used for chronic pain, was indicated as effective in several studies.34 35 3637 One study encouraged providers to try the TENS unit with patients, on the grounds that they found it to be non-invasive, efficient, and easy to use.38 A study led by the same researchers reported proof of TENS' effectiveness.39 Other medications and herbal therapies Other medications and herbal therapies have been studied in the treatment of dysmenorrhea. A 2008 systematic review found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.40 One study indicated that two Japanese herbal medicines provided all of the study participants with complete relief.41 A review indicated the effectiveness of use of transdermal nitroglycerin.42 A double-blind, controlled study indicated that treatment with an extract of guava leaf resulted in significant reduction of symptoms.43 In a small double-blind, placebo-controlled study, guaifenesin reduced primary dysmenorrhea, but the effect was not significant.44 Hormonal treatments One study suggested that vasopressin antagonists with V1a selectivity might be useful in treating a variety of disorders, including dysmenorrhea.45 Prognosis A survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work.46 Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence in this group.47 Epidemiology Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. One study indicated that 67.2% of adolescent females experienced dysmenorrhea.48 A study of Hispanic adolescent females indicated a high prevalence and impact in this group.49 Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity.50 Childbearing can relieve dysmenorrhea.51 One study indicated that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40.51 A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in females who had been sexually abused.52 Secondary dysmenorrhea Please help improve this section by expanding it. Further information might be found on the talk page or at requests for expansion. June 2008 Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis.47 Other causes include leiomyoma,53 adenomyosis,54 ovarian cysts, and pelvic congestions.55 The presence of a copper IUD can also cause dysmenorrhea.5657 In patients with adenomyosis, the levonorgestrel intrauterine system Mirena was observed to provide relief.58 References ^ Latthe P, Mignini L, Gray R, Hills R, Khan K 2006. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 332 7544: 749-55. doi:10.1136/bmj.38748.697465.55. PMID 16484239. ^ Lethaby A, Augood C, Duckitt K, Farquhar C 2007. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev 4: CD000400. doi:10.1002/14651858.CD000400.pub2. PMID 17943741. ^ Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X ^ Rosenwaks Z, Seegar-Jones G October 1980. Menstrual pain: its origin and pathogenesis. J Reprod Med 25 4 Suppl: 207-12. PMID 7001019. ^ Kataoka M, Togashi K, Kido A, et al 2005. Dysmenorrhea: evaluation with cine-mode-display MR imaging--initial experience. Radiology 235 1: 124-31. doi:10.1148/radiol.2351031283. PMID 15731368. ^ Xu L, Liu SL, Zhang JT 2005. --Clausenamide potentiates synaptic transmission in the dentate gyrus of rats. Chirality 17 5: 239-44. doi:10.1002/chir.20150. PMID 15841477. Retrieved on 2008-03-23. ^ Deutch B 1996. Painful menstruation and low intake of n-3 fatty acids in Danish. Ugeskr. Laeg. 158 29: 4195-8. PMID 8701537. ^ Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL 1996. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am. J. Obstet. Gynecol. 174 4: 1335-8. PMID 8623866. ^ Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 fish oil or seal oil capsules, ScienceDirect ^ Prasad K 1997. Dietary flax seed in prevention of hypercholesterolemic atherosclerosis. Atherosclerosis 132 1: 69-76. PMID 9247361. Flax seed is the richest source of omega-3 fatty acid and lignans. ^ Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J 1989. Magnesium--a new therapeutic alternative in primary dysmenorrhea in German. Zentralbl Gynakol 111 11: 755-60. PMID 2675496. ^ Fontana-Klaiber H, Hogg B 1990. Therapeutic effects of magnesium in dysmenorrhea in German. Schweiz. Rundsch. Med. Prax. 79 16: 491-4. PMID 2349410. ^ Ziaei S, Zakeri M, Kazemnejad A 2005. A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea. BJOG 112 4: 466-9. doi:10.1111/j.1471-0528.2004.00495.x. PMID 15777446. ^ Eby GA 2007. Zinc treatment prevents dysmenorrhea. Med. Hypotheses 69 2: 297-301. doi:10.1016/j.mehy.2006.12.009. PMID 17289285. ^ Proctor M, Farquhar C 2006. Diagnosis and management of dysmenorrhoea. BMJ 332 7550: 1134-8. doi:10.1136/bmj.332.7550.1134. PMID 16690671. PMC:1459624. ^ Andreoli, Thomas E., Charles C. J. Carpenter, Robert C. Griggs, and Joseph Loscalzo. CECIL Essentials of Medicine, 6th ed. Saunders, 2004. ISBN 0-7216-0147-2 ^ Rossi S, or. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3 ^ Chantler I, Mitchell D, Fuller A 2008. The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrheic pain. Clin J Pain 24 1: 39-44. doi:10.1097/AJP.0b013e318156dafc inactive 2008-09-09. PMID 18180635. ^ Jia W, Wang X, Xu D, Zhao A, Zhang Y 2006. Common traditional Chinese medicinal herbs for dysmenorrhea. Phytother Res 20 10: 819-24. doi:10.1002/ptr.1905. PMID 16835873. ^ Ostad SN, Soodi M, Shariffzadeh M, Khorshidi N, Marzban H 2001. The effect of fennel essential oil on uterine contraction as a model for dysmenorrhea, pharmacology and toxicology study. J Ethnopharmacol 76 3: 299-304. PMID 11448553. ^ Archer DF November 2006. Menstrual-cycle-related symptoms: a review of the rationale for continuous use of oral contraceptives. Contraception 74 5: 359-66. doi:10.1016/j.contraception.2006.06.003. PMID 17046376. ^ Harel Z December 2006. Dysmenorrhea in adolescents and young adults: etiology and management. J Pediatr Adolesc Gynecol 19 6: 363-71. doi:10.1016/j.jpag.2006.09.001. PMID 17174824. ^ Proctor ML, Roberts H, Farquhar CM 2001. Combined oral contraceptive pill OCP as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev 4: CD002120. doi:10.1002/14651858.CD002120. PMID 11687142. ^ Power J, French R, Cowan F 2007. Subdermal implantable contraceptives versus other forms of reversible contraceptives or other implants as effective methods of preventing pregnancy. Cochrane Database Syst Rev 3: CD001326. doi:10.1002/14651858.CD001326.pub2. PMID 17636668. ^ Glasier, Anna 2006. Contraception, in DeGroot, Leslie J.; Jameson, J. Larry eds.: Endocrinology, 5th ion, Philadelphia: Elsevier Saunders, pp. 2993-3003. ISBN 0-7216-0376-9. ^ Loose, Davis S.; Stancel, George M. 2006. Estrogens and Progestins, in Brunton, Laurence L.; Lazo, John S.; Parker, Keith L. eds.: Goodman Gilman's The Pharmacological Basis of Therapeutics, 11th ed., New York: McGraw-Hill, pp. 1541-1571. ISBN 0-07-142280-3. ^ Gupta HP, Singh U, Sinha S 2007. Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device. J Indian Med Assoc 105 7: 380, 382-5. PMID 18178990. ^ Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM 2007. Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 3: CD002248. doi:10.1002/14651858.CD002248.pub3. PMID 17636702. ^ White A 2003. A review of controlled trials of acupuncture for women's reproductive health care. J Fam Plann Reprod Health Care 29 4: 233-6. doi:10.1783/147118903101197863. PMID 14662058. ^ Jun E 2004. Effects of SP-6 acupressure on dysmenorrhea, skin temperature of CV2 acupoint and temperature, in the college students. Taehan Kanho Hakhoe Chi 34 7: 1343-50. PMID 15687775. ^ Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN 2008. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am. J. Obstet. Gynecol. 198 2: 166.e1-8. doi:10.1016/j.ajog.2007.07.041. PMID 18226614. ^ Chapman-Smith D 2000. Scope of practice, The Chiropractic Profession: Its Education, Practice, Research and Future Directions. West Des Moines, IA: NCMIC. ISBN 1-892734-02-8. ^ Proctor ML, Hing W, Johnson TC, Murphy PA 2006. Spinal manipulation for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 3: CD002119. doi:10.1002/14651858.CD002119.pub3. PMID 16855988. ^ Tugay N, Akbayrak T, Demirtürk F, et al 2007. Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. Pain Med 8 4: 295-300. doi:10.1111/j.1526-4637.2007.00308.x. PMID 17610451. ^ Schiøtz HA, Jettestad M, Al-Heeti D 2007. Treatment of dysmenorrhoea with a new TENS device OVA. J Obstet Gynaecol 27 7: 726-8. doi:10.1080/01443610701612805. PMID 17999304. ^ Proctor ML, Smith CA, Farquhar CM, Stones RW 2002. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev 1: CD002123. doi:10.1002/14651858.CD002123. PMID 11869624. ^ Hedner N, Milsom I, Eliasson T, Mannheimer C 1996. TENS is effective in painful menstruation in Swedish. Lakartidningen 93 13: 1219-22. PMID 8656837. ^ Kaplan B, Rabinerson D, Pardo J, Krieser RU, Neri A 1997. Transcutaneous electrical nerve stimulation TENS as a pain-relief device in obstetrics and gynecology. Clin Exp Obstet Gynecol 24 3: 123-6. PMID 9478293. ^ Kaplan B, Rabinerson D, Lurie S, Peled Y, Royburt M, Neri A 1997. Clinical evaluation of a new model of a transcutaneous electrical nerve stimulation device for the management of primary dysmenorrhea. Gynecol. Obstet. Invest. 44 4: 255-9. PMID 9415524. ^ Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA 2008. Chinese herbal medicine for primary dysmenorrhoea. Cochrane Database Syst Rev 2: CD005288. doi:10.1002/14651858.CD005288.pub3. PMID 18425916. ^ Tanaka T 2003. A novel anti-dysmenorrhea therapy with cyclic administration of two Japanese herbal medicines. Clin Exp Obstet Gynecol 30 2-3: 95-8. PMID 12854851. ^ Morgan PJ, Kung R, Tarshis J 2002. Nitroglycerin as a uterine relaxant: a systematic review. J Obstet Gynaecol Can 24 5: 403-9. PMID 12196860. ^ Doubova SV, Morales HR, Hernández SF, et al 2007. Effect of a Psidii guajavae folium extract in the treatment of primary dysmenorrhea: a randomized clinical trial. J Ethnopharmacol 110 2: 305-10. doi:10.1016/j.jep.2006.09.033. PMID 17112693. ^ Marsden JS, Strickland CD, Clements TL 2004. Guaifenesin as a treatment for primary dysmenorrhea. J Am Board Fam Pract 17 4: 240-6. PMID 15243011. ^ Lemmens-Gruber R, Kamyar M 2008. Pharmacology and clinical relevance of vasopressin antagonists in German. Internist Berl 49 5: 628, 629-30, 632-4. doi:10.1007/s00108-008-2017-z. PMID 18335184. ^ Mozon: Sykemelder seg pÃ¥ grunn av menssmerter 2004-10-25. Retrieved on 2007-02-02. ^ a b French L 2008. Dysmenorrhea in adolescents: diagnosis and treatment. Paediatr Drugs 10 1: 1-7. PMID 18162003. ^ Sharma P, Malhotra C, Taneja DK, Saha R 2008. Problems related to menstruation amongst adolescent girls. Indian J Pediatr 75 2: 125-9. PMID 18334791. ^ Banikarim C, Chacko MR, Kelder SH 2000. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatr Adolesc Med 154 12: 1226-9. PMID 11115307. ^ Sule ST, Umar HS, Madugu NH 2007. Premenstrual symptoms and dysmenorrhoea among Muslim women in Zaria, Nigeria. Ann Afr Med 6 2: 68-72. PMID 18240706. ^ a b Juang CM, Yen MS, Horng HC, Cheng CY, Yuan CC, Chang CM 2006. Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study. J Chin Med Assoc 69 10: 484-8. PMID 17098673. ^ Vink CW, Labots-Vogelesang SM, Lagro-Janssen AL 2006. Menstruation disorders more frequent in women with a history of sexual abuse in Dutch; Flemish. Ned Tijdschr Geneeskd 150 34: 1886-90. PMID 16970013. ^ Hilário SG, Bozzini N, Borsari R, Baracat EC 2008. Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients. Fertil. Steril.. doi:10.1016/j.fertnstert.2007.11.006. PMID 18249392. ^ Nabeshima H, Murakami T, Nishimoto M, Sugawara N, Sato N 2008. Successful total laparoscopic cystic adenomyomectomy after unsuccessful open surgery using transtrocar ultrasonographic guiding. J Minim Invasive Gynecol 15 2: 227-30. doi:10.1016/j.jmig.2007.10.007. PMID 18312998. ^ Hacker, Neville F., J. George Moore, and Joseph C. Gambone. Essentials of Obstetrics and Gynecology, 4th ed. Elsevier Saunders, 2004. ISBN 0-7216-0179-0 ^ Hubacher D, Reyes V, Lillo S, et al 2006. Preventing copper intrauterine device removals due to side effects among first-time users: randomized trial to study the effect of prophylactic ibuprofen. Hum. Reprod. 21 6: 1467-72. doi:10.1093/humrep/del029. PMID 16484309. ^ Johnson BA 2005. Insertion and removal of intrauterine devices. Am Fam Physician 71 1: 95-102. PMID 15663031. ^ Cho S, Nam A, Kim H, et al 2008. Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis. Am. J. Obstet. Gynecol. 198 4: 373.e1-7. doi:10.1016/j.ajog.2007.10.798. PMID 18177833. External links Dysmenorrhea at the Open Directory Project v d e Diseases of the pelvis and genitals N40-N99, 600-629 Female Adnexa Ovary Oophoritis · Ovarian cyst · Ovarian hyperstimulation syndrome · Anovulation · Mittelschmerz Fallopian tube Salpingitis · Hydrosalpinx · Hematosalpinx Parametrium Parametritis Uterus Endometrium: Endometriosis Adenomyosis · Endometrial polyp menstruation Amenorrhoea, Anovulation, Hypomenorrhea, Oligomenorrhea, Menorrhagia, Menometrorrhagia, Metrorrhagia, Dysmenorrhea Hematometra · Retroverted uterus · Asherman's syndrome Cervix Cervicitis - Cervical polyp - Nabothian cyst Vagina Vaginitis Bacterial vaginosis, Atrophic vaginitis · Leukorrhea · Hematocolpos/Hydrocolpos intercourse Dyspareunia, Vaginismus Prolapse Cystocele, Rectocele, Urethrocele · Fistulae Vesicovaginal, Rectovaginal Vulva Vulvitis · Bartholin's cyst Other/general Pelvic inflammatory disease · Female infertility Habitual abortion Male Testicular Orchitis · Hydrocele testis · Testicular torsion · Male infertility Azoospermia, Oligospermia Epididymis Epididymitis · Spermatocele · Hematocele Prostate Prostatitis · Benign prostatic hyperplasia Penis Balanoposthitis/Balanitis · Phimosis · Priapism · Sexual dysfunction Erectile dysfunction · Peyronie's disease Other Hematospermia · Retrograde ejaculation See also congenital, neoplasia v d e Menstrual cycle Events and phases Menstruation · Follicular phase · Ovulation · Luteal phase Life stages Menarche · Menopause Tracking Signs Basal body temperature · Cervical mucus · Mittelschmerz Systems Fertility awareness · Calendar-based methods · Billings Ovulation Method · Creighton Model Suppression Extended cycle combined oral contraceptive pill · Lactational amenorrhea method Disorders Amenorrhoea · Anovulation · Dysmenorrhea · Hypomenorrhea · Menometrorrhagia · Menorrhagia · Metrorrhagia · Oligomenorrhea Related topics Folliculogenesis · McClintock effect · Premenstrual syndrome Retrieved from http://en..org/wiki/Dysmenorrhea Categories: Gynecology | MenstruationHidden categories: Pages with DOIs broken since 2008 | Articles needing additional references from March 2008 | Articles needing additional references from June 2008 | Articles to be expanded since June 2008 | All articles to be expanded Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français Hrvatski Italiano עברית Nederlands Português Runa Simi РуÑ?Ñ?кий Suomi Svenska ä¸æ–‡ This page was last modified on 12 September 2008, at 05
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