Multimodality imaging findings in secondary dysmenorrhea

Dysmenorrhea, characterised by painful menstruation, is a prevalent condition affecting up to 90% of menstruating women, with a significant impact on quality of life and daily functioning. Primary dysmenorrhea occurs without identifiable pelvic pathology as a result of elevated prostaglandins and leukotrienes resulting in uterine contractility and crampy pelvic pain. Secondary dysmenorrhea, on the other hand, arises from identifiable pelvic pathology most commonly endometriosis. Other aetiologies include uterine leiomyomas, adenomyosis, congenital Mullerian duct abnormalities and infection. Accurate diagnosis of pathology in secondary dysmenorrhea is vital for effective management, in order to address patient symptoms and improving outcomes.

This paper explores the multimodality imaging features associated with secondary dysmenorrhea, emphasising the importance of accurate diagnosis in guiding effective treatment strategies.

Pelvic ultrasound, transabdominal and transvaginal, is typically the first-line imaging investigation due to its accessibility and effectiveness. Magnetic resonance imaging (MRI) offers improved soft tissue contrast and assessment of extrauterine anatomy, vital for resolving complex clinical challenges. Computed tomography has a more limited role but is extremely useful in the setting of suspected pelvic inflammatory disease.

We aim to explore the multimodality imaging findings in secondary dysmenorrhea, to aid accurate diagnosis, allowing for timely intervention and improving health outcomes and quality of life for women.