Materiały źródłowe

• #1 Menstrual pain: its origin and pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7001019/

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. […] Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. […] It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. […] Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. […] The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. […] The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #1 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8943241/

  Primary dysmenorrhea (PD) is characterized by painful cramps in the lower abdomen, which start shortly before or at the onset of menses and which could last for 3 days. […] It is suggested that increased intrauterine secretion of prostaglandins F2 and E2 are responsible for the pelvic pain associated with this disorder. […] Although the pathophysiology of dysmenorrhea has not been fully elucidated, current evidence suggests that the pathogenesis of dysmenorrhea is due to the increased secretion of prostaglandin F2 (PGF2) and prostaglandin E2 (PGE2) in the uterus during endometrial sloughing. […] These prostaglandins are involved in increasing myometrial contractions and vasoconstriction, leading to uterine ischemia and production of anaerobic metabolites. […] Consequently, menstrual cramps, pain intensity, and associated symptoms are directly correlated with higher concentrations of PGF2 and PGE2 in the endometrium.

• #2 Inflammatory Markers in Dysmenorrhea and Therapeutic Options

  https://www.mdpi.com/1660-4601/17/4/1191

  Dysmenorrhea often significantly reduces the quality of women’s life and is still an important public health problem. Despite numerous studies, the pathomechanism of dysmenorrhea is not fully understood. Previous research indicates the complexity of biochemical reactions between the endocrine, vascular, and immune systems. Prostaglandins play a major role in the pathomechanism of dysmenorrhea. […] Despite numerous studies, the pathomechanism of dysmenorrhea is not fully understood. Previous studies have shown that dysmenorrhea is a complex process that may depend on many factors. It is known that the menstrual cycle is dependent on cyclic changes in ovarian hormone concentrations, and therefore also on cyclic changes in prostaglandin level and uterine contractile activity. As early as in 1965, Pickles et al. noted that one of the factors contributing to dysmenorrhea may be an increase in prostaglandin concentration before menstruation. These suggestions were confirmed in subsequent years by other authors who have demonstrated that prostaglandins are overproduced in dysmenorrhea. This is also indicated by the symptoms that co-occur with dysmenorrhea during menstruation. Prostaglandins cause narrowing of the blood vessels supplying the uterus, abnormal contractile activity of the uterus, which leads to ischemia, hypoxia of the uterus and increased sensitivity of the nerve endings. […] The mechanisms that follow a decrease in progesterone concentration are complex reactions between the endocrine, vascular and immune systems.

• #2 Menstrual pain: its origin and pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7001019/

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. […] Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. […] It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. […] Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. […] The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. […] The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #3 Menstrual pain: its origin and pathogenesis.

  https://vivo.weill.cornell.edu/display/pubid7001019

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. This paper reviews the various current theories of pathogenicity. It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #4 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  Dysmenorrhea is defined as difficult menstrual flow or painful menstruation. It is one of the most common gynecologic complaints in young women who present to clinicians. Optimal management of this symptom depends on an understanding of the underlying cause. Dysmenorrhea can be divided into two broad categories: primary and secondary. […] Evidence suggests that the pathogenesis of primary dysmenorrhea is due to prostaglandin F2 (PGF2), a potent myometrial stimulant and vasoconstrictor, in the secretory endometrium. […] The response to prostaglandin inhibitors in patients with dysmenorrhea supports the assertion that dysmenorrhea is prostaglandin-mediated. Substantial evidence attributes dysmenorrhea to prolonged uterine contractions and decreased blood flow to the myometrium. […] Elevated prostaglandin levels have been found in the endometrial fluid of women with dysmenorrhea and correlate well with the degree of pain.

• #5 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://www.kjfm.or.kr/journal/view.php?number=4607

  Although the pathophysiology of dysmenorrhea has not been fully elucidated, current evidence suggests that the pathogenesis of dysmenorrhea is due to the increased secretion of prostaglandin F2 (PGF2) and prostaglandin E2 (PGE2) in the uterus during endometrial sloughing. […] These prostaglandins are involved in increasing myometrial contractions and vasoconstriction, leading to uterine ischemia and production of anaerobic metabolites. This results in the hypersensitization of pain fibers, and ultimately pelvic pain. […] Consequently, menstrual cramps, pain intensity, and associated symptoms are directly correlated with higher concentrations of PGF2 and PGE2 in the endometrium.

• #6 Menstrual pain: its origin and pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7001019/

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. […] Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. […] It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. […] Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. […] The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. […] The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #7 Dysmenorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Dysmenorrhea

  Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. […] Painful menstrual cramps can result from an excess of prostaglandins released from the uterus. Prostaglandins cause the uterine muscles to tighten and relax causing the menstrual cramps. This type of dysmenorrhea is called primary dysmenorrhea. […] The underlying mechanism of primary dysmenorrhea is the contractions of the muscles of the uterus which induce a local ischemia. […] Prostaglandins and leukotrienes are released during menstruation, due to the build up of omega-6 fatty acids. Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract and can result in systemic symptoms such as nausea, vomiting, bloating and headaches or migraines. Prostaglandins are thought to be a major factor in primary dysmenorrhea.

• #8 Dysmenorrhea > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/dysmenorrhea

  Dysmenorrhea is the medical term for moderate to severe pain caused by menstrual periods: […] During a menstrual cycle, the uterus produces different levels of chemicals called prostaglandins. Prostaglandins cause uterine contractions, leading to cramping as the uterine muscles contract and relax. Experts believe that high levels of prostaglandins are responsible for primary dysmenorrhea. […] The uterus contracts throughout your menstrual cycle and more strongly during menstruation. But if the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the oxygen supply to muscle tissue. You feel pain when part of the muscle briefly loses its supply of oxygen. […] Secondary dysmenorrhea can be caused by conditions such as: Endometriosis, Uterine adenomyosis, Fibroids, Uterine abnormalities, Ovarian cysts, Pelvic inflammatory disease, Crohns disease, Urinary disorders.

• #9 What causes period cramps

  https://www.delune.co/blogs/blog/what-causes-period-cramps-help-with-cramping-pain-inflammation?srsltid=AfmBOopyfRv_am1sX3JIdaJU-1disUwOU-zVlX6uoks_t2WCQTK8L-UY

  Period cramps are caused by an overproduction of inflammatory compounds in the uterus. They can make uterine muscles contract so tightly, they pinch off blood vessels that supply the uterus with oxygen, leading to painful cramps. […] In a nutshell, inflammation is what causes period cramps. Specifically, menstrual cramps are triggered by pro-inflammatory compounds called prostaglandins. […] The prostaglandins that accumulate in your uterus right before your period are the type that cause inflammationbut for good reason. […] Uterine prostaglandins job is to tell the uterine muscles to contract, or tighten up. […] When we make more prostaglandins than we need at the beginning of our period, uterine muscles contract too tightly. […] When triggered by prostaglandin overload, they can contract so powerfully, they pinch off the blood vessels that supply the uterus with blood, oxygen, and nutrients.

• #10 Dysmenorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Dysmenorrhea

  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, and the resulting temporary oxygen deprivation to nearby tissues, are thought to be responsible for the pain or cramps experienced during menstruation. […] Compared with non-dysmenorrheic individuals, those with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.

• #11 Menstrual pain: its origin and pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7001019/

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. […] Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. […] It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. […] Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. […] The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. […] The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #12 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://kjfm.or.kr/journal/view.php?number=4607

  Although the pathophysiology of dysmenorrhea has not been fully elucidated, current evidence suggests that the pathogenesis of dysmenorrhea is due to the increased secretion of prostaglandin F2 (PGF2) and prostaglandin E2 (PGE2) in the uterus during endometrial sloughing. […] These prostaglandins are involved in increasing myometrial contractions and vasoconstriction, leading to uterine ischemia and production of anaerobic metabolites. This results in the hypersensitization of pain fibers, and ultimately pelvic pain. […] Prostaglandins are synthesized through the arachidonic acid cascade, mediated by the cyclooxygenase (COX) pathway. […] Arachidonic acid synthesis is regulated by the level of progesterone, through the activity of the lysosomal enzyme phospholipase A2. […] The progesterone level peaks during the middle of the luteal phase—the latter phase of the menstrual cycle—that occurs after ovulation.

• #13 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://kjfm.or.kr/journal/view.php?number=4607

  Although the pathophysiology of dysmenorrhea has not been fully elucidated, current evidence suggests that the pathogenesis of dysmenorrhea is due to the increased secretion of prostaglandin F2 (PGF2) and prostaglandin E2 (PGE2) in the uterus during endometrial sloughing. […] These prostaglandins are involved in increasing myometrial contractions and vasoconstriction, leading to uterine ischemia and production of anaerobic metabolites. This results in the hypersensitization of pain fibers, and ultimately pelvic pain. […] Prostaglandins are synthesized through the arachidonic acid cascade, mediated by the cyclooxygenase (COX) pathway. […] Arachidonic acid synthesis is regulated by the level of progesterone, through the activity of the lysosomal enzyme phospholipase A2. […] The progesterone level peaks during the middle of the luteal phase—the latter phase of the menstrual cycle—that occurs after ovulation.

• #14 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://kjfm.or.kr/journal/view.php?number=4607

  If conception does not occur, this results in degeneration of the corpus luteum and a decline in the circulating progesterone level. […] This rapid decline in the progesterone level is associated with endometrial sloughing, menstrual bleeding, and the release of lysosomal enzymes, leading to the generation of arachidonic acid, and therefore, the production of prostaglandins. […] Females with regular menstrual cycles have elevated endometrial prostaglandin levels during the late luteal phase. […] However, several studies that measured prostaglandin concentrations in the luteal phase, through endometrial biopsies and menstrual fluids, revealed that dysmenorrheic females have higher levels of prostaglandins than eumenorrheic females. […] Consequently, menstrual cramps, pain intensity, and associated symptoms are directly correlated with higher concentrations of PGF2 and PGE2 in the endometrium.

• #15 Worse menstrual cramps with anovulation | JPR

  https://www.dovepress.com/menstrual-cramps-in-anovulatory-versus-normally-ovulatory-cycles–sars-peer-reviewed-fulltext-article-JPR

  Currently, overproduction of prostaglandins by the myometrium and endometrium is the explanation for primary dysmenorrhea for which there is the most evidence. Cells released during endometrial sloughing produce prostaglandin F2 and prostaglandin E2. These prostaglandins cause myometrial hypercontractility resulting in ischemia of the uterine muscle, as well as increased sensitivity of nociceptive nerve endings, respectively. […] Prostaglandins are synthesized from arachidonic acid, a process that is controlled by cyclic adenosine phosphate. Prostaglandin production is increased through cyclic adenosine phosphate stimulation by a myriad of signals which include tissue trauma and mechanical stimuli as well as the ovarian hormones (such as estradiol and progesterone), epinephrine and peptide hormones. Arachidonic acid is a derivative of phospholipids released by phospholipase A2, an enzyme found in lysosomes. Lysosomal activity is adjusted by multiple factors; increased progesterone levels stabilize lysosomal activity, but decreasing progesterone removes that stabilizing effect, releasing lysosomal enzymes. During the late luteal phase, the corpus luteum regresses alongside a decrease in progesterone and estradiol levels. This decrease results in the release of phospholipase A2 from lysosomes in the endometrium ultimately raising arachidonic acid (the limiting factor for prostaglandin synthesis) by hydrolyzing phospholipids in the cell membrane. Increased arachidonic acid in conjunction with tissue trauma and intracellular sloughing during menstruation results in an overproduction of prostaglandins during menstruation.

• #16 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://kjfm.or.kr/journal/view.php?number=4607

  If conception does not occur, this results in degeneration of the corpus luteum and a decline in the circulating progesterone level. […] This rapid decline in the progesterone level is associated with endometrial sloughing, menstrual bleeding, and the release of lysosomal enzymes, leading to the generation of arachidonic acid, and therefore, the production of prostaglandins. […] Females with regular menstrual cycles have elevated endometrial prostaglandin levels during the late luteal phase. […] However, several studies that measured prostaglandin concentrations in the luteal phase, through endometrial biopsies and menstrual fluids, revealed that dysmenorrheic females have higher levels of prostaglandins than eumenorrheic females. […] Consequently, menstrual cramps, pain intensity, and associated symptoms are directly correlated with higher concentrations of PGF2 and PGE2 in the endometrium.

• #17 Dysmenorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Dysmenorrhea/item/9

  The increased uterine production and release of prostaglandins at menstruation give rise to increased abnormal uterine activity, which then causes uterine hypoxia and pain. Increased uterine activity and uterine ischemia or hypoxia are two major factors in the causation of the pain. Prostaglandins, such as prostaglandin E2, and cyclic endoperoxides hypersensitize pain fibers in the pelvis and uterus to the action of pain-inducing substances or factors. […] The roles of prostanoids, such as thromboxane A2 and prostacyclin, and leukotrienes in primary dysmenorrhea are not well understood. Preliminary evidence suggests that prostacyclin is involved in the pathophysiology of primary dysmenorrhea. Increased uterine leukotriene may be responsible for some forms of primary dysmenorrhea that do not respond to therapy with NSAIDs, because leukotrienes are produced through the 5-lipoxygenase enzyme pathway rather than the cyclooxygenase pathway.

• #18 Dysmenorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Dysmenorrhea/item/9

  The postulated mechanisms for the generation of pain from pelvic structures in primary dysmenorrhea are summarized in Figure 4. The increased uterine production and release of prostaglandins at menstruation give rise to increased abnormal uterine activity, which then causes uterine hypoxia and pain. Increased uterine activity and uterine ischemia or hypoxia are two major factors in the causation of the pain. Prostaglandins, such as prostaglandin E2, and cyclic endoperoxides hypersensitize pain fibers in the pelvis and uterus to the action of pain-inducing substances or factors.

• #19 Primary Dysmenorrhea: Pathophysiology, Diagnosis, and Treatment Updates

  https://www.kjfm.or.kr/journal/view.php?number=4607

  Although the pathophysiology of dysmenorrhea has not been fully elucidated, current evidence suggests that the pathogenesis of dysmenorrhea is due to the increased secretion of prostaglandin F2 (PGF2) and prostaglandin E2 (PGE2) in the uterus during endometrial sloughing. […] These prostaglandins are involved in increasing myometrial contractions and vasoconstriction, leading to uterine ischemia and production of anaerobic metabolites. This results in the hypersensitization of pain fibers, and ultimately pelvic pain. […] Consequently, menstrual cramps, pain intensity, and associated symptoms are directly correlated with higher concentrations of PGF2 and PGE2 in the endometrium.

• #20 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  The increase in prostaglandins in the endometrium after the fall in progesterone in the late luteal phase results in increased myometrial tone and excessive uterine contraction. […] Leukotrienes have been postulated to heighten the sensitivity of pain fibers in the uterus. […] The posterior pituitary hormone vasopressin may be involved in myometrial hypersensitivity, reduced uterine blood flow, and pain in primary dysmenorrhea. […] In addition, a neuronal hypothesis has been advocated for the pathogenesis of primary dysmenorrhea. […] Women with dysmenorrhea appear to have enhanced pain sensitivity compared to women without dysmenorrhea, even during phases of the menstrual cycle when they are not experiencing menstrual pain. […] Primary dysmenorrhea has also been attributed to behavioral and psychological factors.

• #21 Revealing the mechanism of central pain hypersensitivity in primary dysmenorrhea: evidence from neuroimaging – Jin – Quantitative Imaging in Medicine and Surgery

  https://qims.amegroups.org/article/view/122997/html

  Primary dysmenorrhea (PDM) is the most common problem in menstruating women. A number of functional magnetic resonance imaging (fMRI) study have revealed that the brain plays a crucial role in the pathophysiology of PDM. […] However, recent studies indicate that the brain plays a crucial role in the pathophysiology of PDM, with its involvement encompassing central sensitization, altered pain processing, regulation of neuroendocrine factors, and interactions with psychological factors. […] The results from this study suggest that the mechanism of central pain hypersensitivity of PDM may be related to the disorder of the FC between the PAG and descending pain modulation system, default mode network (DMN), and occipital lobe. […] The findings revealed that there were no functional or structural differences between patients in the PDM-NP and HCs. However, there was evidence of altered brain function and FC patterns of the PAG during the pain phase.

• #22 Revealing the mechanism of central pain hypersensitivity in primary dysmenorrhea: evidence from neuroimaging – Jin – Quantitative Imaging in Medicine and Surgery

  https://qims.amegroups.org/article/view/122997/html

  Primary dysmenorrhea (PDM) is the most common problem in menstruating women. A number of functional magnetic resonance imaging (fMRI) study have revealed that the brain plays a crucial role in the pathophysiology of PDM. […] However, recent studies indicate that the brain plays a crucial role in the pathophysiology of PDM, with its involvement encompassing central sensitization, altered pain processing, regulation of neuroendocrine factors, and interactions with psychological factors. […] The results from this study suggest that the mechanism of central pain hypersensitivity of PDM may be related to the disorder of the FC between the PAG and descending pain modulation system, default mode network (DMN), and occipital lobe. […] The findings revealed that there were no functional or structural differences between patients in the PDM-NP and HCs. However, there was evidence of altered brain function and FC patterns of the PAG during the pain phase.

• #23 Revealing the mechanism of central pain hypersensitivity in primary dysmenorrhea: evidence from neuroimaging – Jin – Quantitative Imaging in Medicine and Surgery

  https://qims.amegroups.org/article/view/122997/html

  Patients in the PDM-P showed increased ReHo in the DLPFC compared with those in the PDM-NP. […] The PAG and DLPFC are considered to be important regions in the descending pain modulation system, and the DLPFC might play a role in pain suppression by regulating the subcortical pathway. […] Therefore, the disorder of descending pain the modulation system may contribute to the mechanisms of the central pain hypersensitivity of PDM. […] Research also indicates there to be abnormal brain function and structural changes in the DMN in patients with PDM, and the maladaptive hypoconnectivity between the PAG and DMN has been identified as the central susceptibility to subsequent development of various functional disorders later in life in patients with PDM. […] Therefore, our results provide evidence suggesting that the hypoconnectivity between the PAG and DMN may be one of the mechanisms of central pain hypersensitivity of PDM.

• #24 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  The increase in prostaglandins in the endometrium after the fall in progesterone in the late luteal phase results in increased myometrial tone and excessive uterine contraction. […] Leukotrienes have been postulated to heighten the sensitivity of pain fibers in the uterus. […] The posterior pituitary hormone vasopressin may be involved in myometrial hypersensitivity, reduced uterine blood flow, and pain in primary dysmenorrhea. […] In addition, a neuronal hypothesis has been advocated for the pathogenesis of primary dysmenorrhea. […] Women with dysmenorrhea appear to have enhanced pain sensitivity compared to women without dysmenorrhea, even during phases of the menstrual cycle when they are not experiencing menstrual pain. […] Primary dysmenorrhea has also been attributed to behavioral and psychological factors.

• #25 Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0115/p285.html

  Dysmenorrhea is thought to be caused by the release of prostaglandins in the menstrual fluid, which causes uterine contractions and pain. Vasopressin also may play a role by increasing uterine contractility and causing ischemic pain as a result of vasoconstriction. Elevated vasopressin levels have been reported in women with primary dysmenorrhea. […] The relationship between endometriosis and dysmenorrhea is not clear. Endometriosis may be asymptomatic, or it may be associated with pelvic pain that is not limited to the menstrual period and the low anterior pelvis. In one study of women undergoing elective sterilization, no difference was found in the prevalence of dysmenorrhea in women with and women without an incidental finding of endometriosis. However, an observational study of women undergoing laparoscopy for infertility supported a relationship between dysmenorrhea and the severity of endometriosis.

• #26 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  The increase in prostaglandins in the endometrium after the fall in progesterone in the late luteal phase results in increased myometrial tone and excessive uterine contraction. […] Leukotrienes have been postulated to heighten the sensitivity of pain fibers in the uterus. […] The posterior pituitary hormone vasopressin may be involved in myometrial hypersensitivity, reduced uterine blood flow, and pain in primary dysmenorrhea. […] In addition, a neuronal hypothesis has been advocated for the pathogenesis of primary dysmenorrhea. […] Women with dysmenorrhea appear to have enhanced pain sensitivity compared to women without dysmenorrhea, even during phases of the menstrual cycle when they are not experiencing menstrual pain. […] Primary dysmenorrhea has also been attributed to behavioral and psychological factors.

• #27 Dysmenorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Dysmenorrhea/item/9

  The increased uterine production and release of prostaglandins at menstruation give rise to increased abnormal uterine activity, which then causes uterine hypoxia and pain. Increased uterine activity and uterine ischemia or hypoxia are two major factors in the causation of the pain. Prostaglandins, such as prostaglandin E2, and cyclic endoperoxides hypersensitize pain fibers in the pelvis and uterus to the action of pain-inducing substances or factors. […] The roles of prostanoids, such as thromboxane A2 and prostacyclin, and leukotrienes in primary dysmenorrhea are not well understood. Preliminary evidence suggests that prostacyclin is involved in the pathophysiology of primary dysmenorrhea. Increased uterine leukotriene may be responsible for some forms of primary dysmenorrhea that do not respond to therapy with NSAIDs, because leukotrienes are produced through the 5-lipoxygenase enzyme pathway rather than the cyclooxygenase pathway.

• #28 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  The increase in prostaglandins in the endometrium after the fall in progesterone in the late luteal phase results in increased myometrial tone and excessive uterine contraction. […] Leukotrienes have been postulated to heighten the sensitivity of pain fibers in the uterus. […] The posterior pituitary hormone vasopressin may be involved in myometrial hypersensitivity, reduced uterine blood flow, and pain in primary dysmenorrhea. […] In addition, a neuronal hypothesis has been advocated for the pathogenesis of primary dysmenorrhea. […] Women with dysmenorrhea appear to have enhanced pain sensitivity compared to women without dysmenorrhea, even during phases of the menstrual cycle when they are not experiencing menstrual pain. […] Primary dysmenorrhea has also been attributed to behavioral and psychological factors.

• #29 Treatments for cramps don’t cut it. Why aren’t there better options?

  https://www.statnews.com/2023/02/17/cramps-menstrual-period-pain-treatment/

  Payne is studying how emotions and pain perception interact with dysmenorrhea. Theres that emotional component to the pain experience that we know can make the pain experience worse, she said. Some people with dysmenorrhea have a higher risk of developing chronic pain, and she is studying if pain perception plays a role. If it does, she said, cognitive behavioral therapy may stop chronic pain from emerging, although no research has demonstrated this yet.

• #30 Treatments for cramps don’t cut it. Why aren’t there better options?

  https://www.statnews.com/2023/02/17/cramps-menstrual-period-pain-treatment/

  Payne is studying how emotions and pain perception interact with dysmenorrhea. Theres that emotional component to the pain experience that we know can make the pain experience worse, she said. Some people with dysmenorrhea have a higher risk of developing chronic pain, and she is studying if pain perception plays a role. If it does, she said, cognitive behavioral therapy may stop chronic pain from emerging, although no research has demonstrated this yet.

• #31 A Root Cause Medicine Approach to Managing Menstrual Cramps

  https://www.rupahealth.com/post/a-root-cause-medicine-approach-to-managing-menstrual-cramps

  Stress reduction undeniably factors in for managing and alleviating menstrual cramps. There’s a positive relationship between the severity of psychological stress and the severity of dysmenorrhea. […] Regular physical activity can significantly help manage menstrual cramps so they are more manageable. […] Women who exercise regularly may experience fewer menstrual cramps. […] Women who participate in regular exercise of 45-60 minutes three times per week, regardless of intensity, report less pain during menstruation compared to sedentary women. […] Women seem to be increasingly exploring complementary and integrative therapies for managing menstrual cramps. Notably, treatments such as herbal remedies, acupuncture, acupressure, TENS units, and heat therapies like castor oil packs and moxibustion are emerging as supportive alternative therapies for menstrual cramps.

• #32 A Root Cause Medicine Approach to Managing Menstrual Cramps

  https://www.rupahealth.com/post/a-root-cause-medicine-approach-to-managing-menstrual-cramps

  Stress reduction undeniably factors in for managing and alleviating menstrual cramps. There’s a positive relationship between the severity of psychological stress and the severity of dysmenorrhea. […] Regular physical activity can significantly help manage menstrual cramps so they are more manageable. […] Women who exercise regularly may experience fewer menstrual cramps. […] Women who participate in regular exercise of 45-60 minutes three times per week, regardless of intensity, report less pain during menstruation compared to sedentary women. […] Women seem to be increasingly exploring complementary and integrative therapies for managing menstrual cramps. Notably, treatments such as herbal remedies, acupuncture, acupressure, TENS units, and heat therapies like castor oil packs and moxibustion are emerging as supportive alternative therapies for menstrual cramps.

• #33 Dysmenorrhea and Endometriosis in the Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

  Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women. Most adolescents experiencing dysmenorrhea have primary dysmenorrhea, defined as painful menstruation in the absence of pelvic pathology. […] Secondary dysmenorrhea refers to painful menses due to pelvic pathology or a recognized medical condition. The most common cause of secondary dysmenorrhea is endometriosis. […] Although the true prevalence of endometriosis in adolescents is unknown, at least two thirds of adolescent girls with chronic pelvic pain or dysmenorrhea unresponsive to hormonal therapies and NSAIDs will be diagnosed with endometriosis at the time of diagnostic laparoscopy. […] Endometriosis is the leading cause of secondary dysmenorrhea in adolescents. Endometriosis should be considered in patients with persistent, clinically significant dysmenorrhea despite treatment with hormonal agents and nonsteroidal antiinflammatory drugs, particularly if no other etiology for chronic pelvic pain or secondary dysmenorrhea has been identified based on history, physical examination, and pelvic ultrasonography.

• #34 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Dysmenorrhea is one of the most common causes of pelvic pain. It negatively affects patients’ quality of life and sometimes results in activity restriction. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. […] Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. […] Dysmenorrhea is considered primary in the absence of underlying pathology. Onset is typically six to 12 months after menarche, with peak prevalence occurring in the late teens or early twenties. Secondary dysmenorrhea results from specific pelvic pathology. […] Endometriosis is the most common cause of secondary dysmenorrhea. The incidence is highest among women 25 to 29 years of age and lowest among women older than 44 years.

• #35 Dysmenorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Dysmenorrhea/item/9

  Dysmenorrhea, one of the most frequently encountered gynecologic disorders, refers to painful menstruation. Dysmenorrhea is classified as primary or secondary dysmenorrhea. Primary dysmenorrhea is defined as painful menstrual cramps in the absence of any visible pelvic pathology that could account for it. In secondary dysmenorrhea, the painful menstruation is accompanied by visible pelvic pathology that accounts for the pain. Such a classification allows practical differentiation in the management approach, which is based on the causal mechanism. […] Primary dysmenorrhea usually begins a few hours before or just after the onset of menstruation. The cramps are most severe on the first or second day of menstruation. Characteristically, the pains are spasmodic in nature and strongest over the lower abdomen, but they may also radiate to the back and the inner aspects of the thigh, and they are often described as labor-like pains. The cramp is commonly accompanied by one or more systemic symptoms, including nausea and vomiting (89%), fatigue (85%), diarrhea (60%), lower backache (60%), and headache (45%).

• #36 Dysmenorrhea | GLOWM

  https://www.glowm.com/section-view/heading/Dysmenorrhea/item/9

  Dysmenorrhea, one of the most frequently encountered gynecologic disorders, refers to painful menstruation. Dysmenorrhea is classified as primary or secondary dysmenorrhea. Primary dysmenorrhea is defined as painful menstrual cramps in the absence of any visible pelvic pathology that could account for it. In secondary dysmenorrhea, the painful menstruation is accompanied by visible pelvic pathology that accounts for the pain. Such a classification allows practical differentiation in the management approach, which is based on the causal mechanism. […] Primary dysmenorrhea usually begins a few hours before or just after the onset of menstruation. The cramps are most severe on the first or second day of menstruation. Characteristically, the pains are spasmodic in nature and strongest over the lower abdomen, but they may also radiate to the back and the inner aspects of the thigh, and they are often described as labor-like pains. The cramp is commonly accompanied by one or more systemic symptoms, including nausea and vomiting (89%), fatigue (85%), diarrhea (60%), lower backache (60%), and headache (45%).

• #37 Dysmenorrhea – Wikipedia

  https://en.wikipedia.org/wiki/Dysmenorrhea

  Dysmenorrhea, also known as period pain, painful periods or menstrual cramps, is pain during menstruation. […] Painful menstrual cramps can result from an excess of prostaglandins released from the uterus. Prostaglandins cause the uterine muscles to tighten and relax causing the menstrual cramps. This type of dysmenorrhea is called primary dysmenorrhea. […] The underlying mechanism of primary dysmenorrhea is the contractions of the muscles of the uterus which induce a local ischemia. […] Prostaglandins and leukotrienes are released during menstruation, due to the build up of omega-6 fatty acids. Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract and can result in systemic symptoms such as nausea, vomiting, bloating and headaches or migraines. Prostaglandins are thought to be a major factor in primary dysmenorrhea.

• #38 Period Pain | Menstrual Cramps | MedlinePlus

  https://medlineplus.gov/periodpain.html

  Menstrual cramps, also called dysmenorrhea, are a throbbing, cramping pain in your lower abdomen. […] Primary dysmenorrhea is the most common kind of period pain. The cause is usually having too many prostaglandins, which are chemicals that your uterus makes. These chemicals make the muscles of your uterus tighten and relax, and this causes the cramps. […] Secondary dysmenorrhea often starts later in life. It is caused by conditions that affect your uterus or other reproductive organs, such as endometriosis and uterine fibroids. This kind of pain often gets worse over time.

• #39 Diagnosis and Initial Management of Dysmenorrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0301/p341.html

  Dysmenorrhea is one of the most common causes of pelvic pain. It negatively affects patients’ quality of life and sometimes results in activity restriction. Primary dysmenorrhea is menstrual pain in the absence of pelvic pathology. […] Endometriosis is the most common cause of secondary dysmenorrhea. Symptoms and signs of adenomyosis include dysmenorrhea, menorrhagia, and a uniformly enlarged uterus. […] Dysmenorrhea is considered primary in the absence of underlying pathology. Onset is typically six to 12 months after menarche, with peak prevalence occurring in the late teens or early twenties. Secondary dysmenorrhea results from specific pelvic pathology. […] Endometriosis is the most common cause of secondary dysmenorrhea. The incidence is highest among women 25 to 29 years of age and lowest among women older than 44 years.

• #40 Dysmenorrhea and Endometriosis in the Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

  Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women. Most adolescents experiencing dysmenorrhea have primary dysmenorrhea, defined as painful menstruation in the absence of pelvic pathology. […] Secondary dysmenorrhea refers to painful menses due to pelvic pathology or a recognized medical condition. The most common cause of secondary dysmenorrhea is endometriosis. […] Although the true prevalence of endometriosis in adolescents is unknown, at least two thirds of adolescent girls with chronic pelvic pain or dysmenorrhea unresponsive to hormonal therapies and NSAIDs will be diagnosed with endometriosis at the time of diagnostic laparoscopy. […] Endometriosis is the leading cause of secondary dysmenorrhea in adolescents. Endometriosis should be considered in patients with persistent, clinically significant dysmenorrhea despite treatment with hormonal agents and nonsteroidal antiinflammatory drugs, particularly if no other etiology for chronic pelvic pain or secondary dysmenorrhea has been identified based on history, physical examination, and pelvic ultrasonography.

• #41 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  In primary dysmenorrhea, there is a highly complex interplay between hormones and mediators, basal body temperature, sleep patterns, and the central nervous system (CNS), the extent of which is not completely understood. […] Elevated prostaglandins may also play a role in secondary dysmenorrhea, but by definition, concomitant pelvic pathology must be present. […] A number of factors may be involved in the pathogenesis of secondary dysmenorrhea, including endometriosis, pelvic inflammatory disease (PID), ovarian cysts and tumors, cervical stenosis or occlusion, adenomyosis, fibroids, uterine polyps, intrauterine adhesions, congenital malformations, intrauterine contraceptive device (IUCD), transverse vaginal septum, pelvic congestion syndrome, and Allen-Masters syndrome. […] Almost any process that can affect the pelvic viscera can produce cyclic pelvic pain.

• #42 Painful Menstrual Periods: Causes, Treatments & More

  https://www.healthline.com/health/painful-menstrual-periods

  Painful menstruation is called dysmenorrhea. There are two types: primary and secondary. Certain medical conditions, including endometriosis and pelvic inflammatory disease, can cause it. […] A hormone called prostaglandin triggers muscle contractions in your uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins. […] Painful menstrual periods can also be the result of an underlying medical condition, such as: Endometriosis. This is a painful medical condition in which cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis. […] Adenomyosis. This is a rare condition in which the uterine lining grows into the muscular wall of the uterus, causing inflammation, pressure, and pain. It can also cause longer or heavier periods.

• #43 Dysmenorrhea and Endometriosis in the Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

  The appearance of endometriosis may be different in an adolescent than in an adult woman. In adolescents, endometriotic lesions are typically clear or red and can be difficult to identify for gynecologists unfamiliar with endometriosis in adolescents. […] Endometriosis in adolescents is considered a chronic disease with potential for progression if left untreated. The goals of therapy include symptom relief, suppression of disease progression, and protection of future fertility. […] Like endometriosis in adults, endometriosis in adolescents is considered an inflammatory-mediated estrogen-dependent disorder. Estrogen produced by the ovaries, as well as estrogen produced locally by the endometriotic implants due to aromatase activity, promotes increased prostaglandin production, resulting in pain.

• #44 Dysmenorrhea and Endometriosis in the Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent

  Dysmenorrhea, or menstrual pain, is the most common menstrual symptom among adolescent girls and young women. Most adolescents experiencing dysmenorrhea have primary dysmenorrhea, defined as painful menstruation in the absence of pelvic pathology. […] Secondary dysmenorrhea refers to painful menses due to pelvic pathology or a recognized medical condition. The most common cause of secondary dysmenorrhea is endometriosis. […] Although the true prevalence of endometriosis in adolescents is unknown, at least two thirds of adolescent girls with chronic pelvic pain or dysmenorrhea unresponsive to hormonal therapies and NSAIDs will be diagnosed with endometriosis at the time of diagnostic laparoscopy. […] Endometriosis is the leading cause of secondary dysmenorrhea in adolescents. Endometriosis should be considered in patients with persistent, clinically significant dysmenorrhea despite treatment with hormonal agents and nonsteroidal antiinflammatory drugs, particularly if no other etiology for chronic pelvic pain or secondary dysmenorrhea has been identified based on history, physical examination, and pelvic ultrasonography.

• #45 Journal of Pain Research – Dove Press Open Access Publisher | Dysmenorrhea: Therapy and Mechanism

  https://www.dovepress.com/journal-of-pain-research-archive41-collection121

  Dysmenorrhea, commonly known as menstrual cramps, is a widespread gynecological disorder that affects a significant number of women worldwide. […] Despite its high prevalence, effective treatments and a clear understanding of the underlying mechanisms are still lacking. […] This Article Collection addresses issues of pathophysiology, pharmacological and non-pharmacological interventions, and potential mechanisms for dysmenorrhea.

• #46 Dysmenorrhea: Epidemiology, Causes and Current State of the Art for Treatment

  https://www.imrpress.com/journal/CEOG/50/12/10.31083/j.ceog5012274/htm

  The mechanisms described above are showed in Fig. 1. […] Pain fibers are excited by leukotrienes also; these fibers in the uterus activate the afferent pain pathways to the central nervous system. […] A genome-wide association study showed that common variants in the ZMIZ1 gene (rs76518691 locus) and in the NGF gene (rs7523831) conferred a risk of primary dysmenorrhea. […] The pathogenesis of this disease is not well-known, and some controversies remain limiting efficacy of long-term treatment. […] The main cause of this disease is endometriosis. […] Dysmenorrhea of recent onset, associated with pelvic tenderness and abnormal vaginal secretions should suggest an infectious etiology. […] Theological and traditional attitudes regarding menstruation, as well as the common belief in some patients that pain is an expected and unavoidable part of menstruation, could underlie the dual failures of omission or lack of communication.

• #47 RETRACTED ARTICLE: A one-year observational cohort study of menstrual cramps and ovulation in healthy, normally ovulating women | Scientific Reports

  https://www.nature.com/articles/s41598-022-08658-3

  These prospective observational data for 13.6 cycles/woman in 53 healthy, regularly cycling and screened-to-be-normally ovulatory women documented cramp characteristics were similar between ovulatory and anovulatory cycles. In contrast to the current hypothesis that cycles without normal ovulation lack cramps, in within-woman analysis there was no difference in Cramp Scores in SOD cycles compared with normally ovulatory cycles. However, the SOD cycles showed significantly higher cramp intensity than normally ovulatory ones. […] Evidence now suggests that subclinical ovulatory disturbances occur in over a third of normal-length, spontaneous menstrual cycles. Our data documented that cramp prevalence, duration, intensity, and Cramp Score were similar in ovulatory and anovulatory cycles within-woman.

• #48 Worse menstrual cramps with anovulation | JPR

  https://www.dovepress.com/menstrual-cramps-in-anovulatory-versus-normally-ovulatory-cycles–sars-peer-reviewed-fulltext-article-JPR

  Our primary purpose in this investigation of the relationship of primary dysmenorrhea to ovulatory characteristics was to report the intensity, duration and a Cramp Score integrating both measures in women in the Menstruation and Ovulation Study 2 (MOS2) that documented one cycle per participant, examining all normally ovulatory versus all anovulatory cycles. Our secondary purposes were to tabulate and provide a meta-analysis of data from the previously published studies on menstrual cramps and ovulation or anovulation to examine the prevalence of cramps in the two cycle types. […] Previous research has asserted that ovulation is required for the presence of primary dysmenorrhea. However, there is now substantial evidence showing that it is possible to have menstrual cramps during anovulatory cycles. Ultimately, it is likely that the progesterone-prostaglandin relationship is not the major factor related to primary dysmenorrhea. Thus, primary menstrual cramp characteristics are all significantly greater in same-length anovulatory compared with normally ovulatory menstrual cycles in well-educated community women in their late 20s and early 30s. This prompts a new era of scientific investigation into the relationships of ovarian hormones, the balance of estradiol and progesterone levels and their menstrual cycle-related changes in association with the pathophysiology of primary dysmenorrhea.

• #49 Treatments for cramps don’t cut it. Why aren’t there better options?

  https://www.statnews.com/2023/02/17/cramps-menstrual-period-pain-treatment/

  One of those possible treatments is the erectile dysfunction drug Viagra. Sildenafil citrate (the generic version of Viagra) increases blood flow by dilating blood vessels. Prostaglandins, the compounds blocked by NSAIDs, may build up inside the blood vessels in the uterus, which could contribute to pain. […] Theoretically, dilating blood vessels in the uterus could lead to kind of a flushing away of those painful stimulants, said Richard Legro, an OB-GYN and reproductive endocrinology researcher at Penn State who launched a clinical trial in 2007 to study the treatment. He also hypothesized the drug could bring more oxygen to the uterus low oxygen levels can change the local pH and stimulate nerve endings, leading to pain. […] Researchers are getting creative about how to carry on their work despite those challenges. Hellman developed an MRI technique to visualize whats going on in the uterus during menstrual cramps. He is currently using the technique in a clinical trial to test whether NSAIDs stop contractions. If NSAIDs dont work for someone, this method should reveal why. It could be a drug absorption issue, but if the person never had contractions to begin with, there may be a different cause for the pain.

• #50 Treatments for cramps don’t cut it. Why aren’t there better options?

  https://www.statnews.com/2023/02/17/cramps-menstrual-period-pain-treatment/

  One of those possible treatments is the erectile dysfunction drug Viagra. Sildenafil citrate (the generic version of Viagra) increases blood flow by dilating blood vessels. Prostaglandins, the compounds blocked by NSAIDs, may build up inside the blood vessels in the uterus, which could contribute to pain. […] Theoretically, dilating blood vessels in the uterus could lead to kind of a flushing away of those painful stimulants, said Richard Legro, an OB-GYN and reproductive endocrinology researcher at Penn State who launched a clinical trial in 2007 to study the treatment. He also hypothesized the drug could bring more oxygen to the uterus low oxygen levels can change the local pH and stimulate nerve endings, leading to pain. […] Researchers are getting creative about how to carry on their work despite those challenges. Hellman developed an MRI technique to visualize whats going on in the uterus during menstrual cramps. He is currently using the technique in a clinical trial to test whether NSAIDs stop contractions. If NSAIDs dont work for someone, this method should reveal why. It could be a drug absorption issue, but if the person never had contractions to begin with, there may be a different cause for the pain.

• #51 Dysmenorrhea: Epidemiology, Causes and Current State of the Art for Treatment

  https://www.imrpress.com/journal/CEOG/50/12/10.31083/j.ceog5012274/htm

  The mechanisms described above are showed in Fig. 1. […] Pain fibers are excited by leukotrienes also; these fibers in the uterus activate the afferent pain pathways to the central nervous system. […] A genome-wide association study showed that common variants in the ZMIZ1 gene (rs76518691 locus) and in the NGF gene (rs7523831) conferred a risk of primary dysmenorrhea. […] The pathogenesis of this disease is not well-known, and some controversies remain limiting efficacy of long-term treatment. […] The main cause of this disease is endometriosis. […] Dysmenorrhea of recent onset, associated with pelvic tenderness and abnormal vaginal secretions should suggest an infectious etiology. […] Theological and traditional attitudes regarding menstruation, as well as the common belief in some patients that pain is an expected and unavoidable part of menstruation, could underlie the dual failures of omission or lack of communication.

• #52 A Root Cause Medicine Approach to Managing Menstrual Cramps

  https://www.rupahealth.com/post/a-root-cause-medicine-approach-to-managing-menstrual-cramps

  Stress reduction undeniably factors in for managing and alleviating menstrual cramps. There’s a positive relationship between the severity of psychological stress and the severity of dysmenorrhea. […] Regular physical activity can significantly help manage menstrual cramps so they are more manageable. […] Women who exercise regularly may experience fewer menstrual cramps. […] Women who participate in regular exercise of 45-60 minutes three times per week, regardless of intensity, report less pain during menstruation compared to sedentary women. […] Women seem to be increasingly exploring complementary and integrative therapies for managing menstrual cramps. Notably, treatments such as herbal remedies, acupuncture, acupressure, TENS units, and heat therapies like castor oil packs and moxibustion are emerging as supportive alternative therapies for menstrual cramps.

• #53 Menstrual pain Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/menstrual-pain

  Primary dysmenorrhea is caused by strong contractions of the uterus triggered by prostaglandins, chemicals in the body that are involved in inflammation and pain. Generally, the higher the levels of prostaglandins, the more menstrual pain. […] Secondary dysmenorrhea can be caused by: […] Uterine infections. […] Acupuncture has become a popular treatment for menstrual pain. The National Institutes of Health recommends acupuncture, either by itself or along with other treatments, for menstrual pain. In a well-designed study of 43 women with menstrual pain, women treated with acupuncture had less pain and needed less pain medication. […] Acupuncturists treat people with dysmenorrhea based on an individualized assessment of the excesses and deficiencies of energy (called qi) located in various meridians. In the case of dysmenorrhea, a qi deficiency is usually detected in the liver and spleen meridians.

• #54 Menstrual pain: its origin and pathogenesis.

  https://vivo.weill.cornell.edu/display/pubid7001019

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. This paper reviews the various current theories of pathogenicity. It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #55 Menstrual pain: its origin and pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/7001019/

  A variety of misconceptions about the etiology of dysmenorrhea have existed in the past. […] Experimental and clinical research of the last 15 years, however, has identified uterine prostaglandins as substantially contributing to the pathogenesis of primary dysmenorrhea. […] It is now known that at the end of the menstrual cycle, prostaglandins increase myometrial contractions and cause constriction of small endometrial blood vessels, with consequent tissue ischemia, endometrial disintegration, bleeding and pain. […] Dysmenorrhea may be due to tissue ischemia resulting from increased intrauterine pressure, vessel constriction and decreased uterine blood flow. […] The most compelling evidence for the „prostaglandin theory” is the success of prostaglandin synthesis inhibitors in the treatment of dysmenorrhea. […] The pain relief achieved with these drugs is accompanied by a suppression of prostaglandin synthesis and a decrease in intrauterine pressure.

• #56 Dysmenorrhea: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/253812-overview

  In primary dysmenorrhea, there is a highly complex interplay between hormones and mediators, basal body temperature, sleep patterns, and the central nervous system (CNS), the extent of which is not completely understood. […] Elevated prostaglandins may also play a role in secondary dysmenorrhea, but by definition, concomitant pelvic pathology must be present. […] A number of factors may be involved in the pathogenesis of secondary dysmenorrhea, including endometriosis, pelvic inflammatory disease (PID), ovarian cysts and tumors, cervical stenosis or occlusion, adenomyosis, fibroids, uterine polyps, intrauterine adhesions, congenital malformations, intrauterine contraceptive device (IUCD), transverse vaginal septum, pelvic congestion syndrome, and Allen-Masters syndrome. […] Almost any process that can affect the pelvic viscera can produce cyclic pelvic pain.

• #57 Revealing the mechanism of central pain hypersensitivity in primary dysmenorrhea: evidence from neuroimaging – Jin – Quantitative Imaging in Medicine and Surgery

  https://qims.amegroups.org/article/view/122997/html

  Primary dysmenorrhea (PDM) is the most common problem in menstruating women. A number of functional magnetic resonance imaging (fMRI) study have revealed that the brain plays a crucial role in the pathophysiology of PDM. […] However, recent studies indicate that the brain plays a crucial role in the pathophysiology of PDM, with its involvement encompassing central sensitization, altered pain processing, regulation of neuroendocrine factors, and interactions with psychological factors. […] The results from this study suggest that the mechanism of central pain hypersensitivity of PDM may be related to the disorder of the FC between the PAG and descending pain modulation system, default mode network (DMN), and occipital lobe. […] The findings revealed that there were no functional or structural differences between patients in the PDM-NP and HCs. However, there was evidence of altered brain function and FC patterns of the PAG during the pain phase.

• #58

  https://research-archive.org/index.php/rars/preprint/view/1569

  The prevalence of menstrual pain is high yet there is a lack of research and understanding of it. […] Much research has been dedicated to understanding the biochemistry of the mechanisms of these medicines and how pain is generated at a molecular level. […] I argue that future research should focus on menstrual pain specifically and how to alleviate it with more targeted therapies. […] These broad efforts will enhance our understanding of reproductive health sciences and have a significant impact on a large portion of the human population.

• #59 Management of Dysmenorrhea – Walter Bushnell Healthcare Foundation

  https://wbhf.walterbushnell.com/publications/bush-beats/item/66-management-of-dysmenorrhea

  Dysmenorrhea – referred to as painful menstrual cramps of uterine origin – is an extremely common condition for women of reproductive age. […] The exact cause of dysmenorrhea is not completely understood, and it possibly includes multiple factors with unexplained mechanisms. However, there are certain known factors that seem to play significant roles in its pathogenesis; most important among these factors include excessive uterine contractility, disturbances in uterine blood supply, synthesis of prostaglandins, and anatomical abnormalities of the female reproductive tract. […] An excessive or imbalanced amount of prostanoids and possibly eicosanoids released from the endometrium during menstruation is implicated in the increased uterine contractions seen in dysmenorrhea. […] In isolation, the mechanism of prostaglandin for pain could be implicated in both primary and secondary dysmenorrhea; prostaglandins cause myometrial contractility that, when excessive, leads to uterine hypoxia and ischemia and pain.

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