Current concepts in the etiology and treatment of primary dysmenorrhea

Primary dysmenorrhea may affect as many as 40 percent of all adult women, temporarily disabling one-tenth of them. The etiology of this condition may be related to excess production of prostaglandins by the endometrium following decline in progesterone levels consequent to corpus luteum regression. It is proposed that increased prostaglandin levels produce increased myometrial contractility and uterine ischemia and sensitization of pain fibers, resulting in pelvic pain. Administration of nonsteroidal anti-inflammatory agents which block the cyclooxygenase enzyme of the arachidonic acid cascade is an effective treatment for primary dysmenorrhea, as is oral contraceptive therapy. Criteria for an ideal prostaglandin synthetase inhibitor are described.