Primary dysmenorrhea

In primary dysmenorrhea, onset of pain generally occurs approximately one year following menarche when ovu-latory cycles are established. The pain starts near or at the onset of menses, lasting for 48-72 hours, is suprapubic and cramping, radiating to the lumbosacral region and anterior thighs. Associated gastrointestinal symptoms including nausea, vomiting, and diarrhea are common.

Secondary dysmenorrhea usually occurs years after menarche, and pain may occur up to two weeks prior to the onset of menses and last until the cessation of menses. In primary dysmenorrhea, the physical examination is unremarkable, although at the time of dysmenorrhea some suprapubic and uterine tenderness is common, whereas with secondary dysmenorrhea, careful pelvic examination may reveal abnormalities in adnexal structures, uterine size, contour, mobility and/or tenderness, and nodularity of the uterosacral ligaments and rectovaginal septum.

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