Distinguish between primary and secondary dysmenorrhea

Professional consultation article by Doctor Department of Obstetrics and Gynecology, Vinmec Hai Phong International General Hospital.

Dysmenorrhea is a constant and spasmodic pain in a woman's lower abdomen. This phenomenon is divided into two types depending on the cause: primary dysmenorrhea and secondary dysmenorrhea.

Dysmenorrhea (or dysmenorrhea) is a very common symptom, related to the menstrual cycle of women. Almost every woman has experienced menstrual cramps at least once in her life. This condition often causes spasm-like pain in the lower abdomen, which can radiate to the back and down the thighs.
Dysmenorrhea can be very intense at times, but usually it is just a sharp pain and a little discomfort in the abdomen. Dysmenorrhea may not be the same between periods. Sometimes there are periods when there is no menstrual pain or only mild discomfort for the woman, but there are periods that cause severe pain. On the other hand, some women may experience lower abdominal pain even when not menstruating.
Depending on the cause, this phenomenon is divided into 2 types:

1.1 Primary dysmenorrhea Primary dysmenorrhea occurs due to contractions of the uterus. The contractions are small, the pain is located vertically from the top to the bottom of the uterus, but these uterine contractions are usually quite weak and difficult to feel clearly. During the menstrual period, a woman's uterus will contract regularly to expel all the necrotic uterine lining elements to the outside, creating menstrual blood. When contracting, blood vessels are tightens, resulting in less blood and oxygen coming in. This lack of oxygen sends out signals that stimulate the body to release pain-causing chemicals. At the same time, prostaglandins are also produced, which causes the uterus to contract more, leading to more pain. Primary dysmenorrhea usually improves as a woman ages, especially after having children.

1.2. Secondary dysmenorrhea Secondary dysmenorrhea is less common and is caused by a medical condition. The condition is age-related and is more common in women between the ages of 30 and 45. Medical disorders that can cause secondary dysmenorrhea include:
Endometriosis : Normally the endometrium is originally inside the uterus, but in this situation it is out of place. Other locations outside the uterus such as: fallopian tubes, ovaries, .... causing lower abdominal pain. Uterine fibroids: Fibroids that grow in the uterus can cause menorrhagia and dysmenorrhea. Pelvic inflammatory disease: Causes the organs in the pelvic region such as the uterus, fallopian tubes, and ovaries to become inflamed. Endometriosis: Endometriosis is the "ectopic" of the cells of the endometrium into the muscular layer of the uterus, leading to secondary dysmenorrhea. Contraceptive device: Placed inside the uterus to prevent pregnancy. However, this method is also one of the causes of unwanted menstrual pain, especially with menstrual cycles after the insertion of the IUD. In addition, women should also watch out for irregular periods during their menstrual cycle, because it could be a symptom related to one of the causes of secondary dysmenorrhea as listed above. . Unusual symptoms such as: Menstrual cramps that are stronger or last longer than usual.
If it is secondary dysmenorrhea with the above causes, the following symptoms may accompany it:
Irregular menstruation Irregular bleeding between periods Severe pain during intercourse Heavy or heavy discharge bad smell If you notice any of the above symptoms, talk to your doctor frankly to get the right treatment.

The majority of cases are mild primary dysmenorrhea that does not require treatment, or if present, usually only needs to be treated at home. Treatment methods applied are:
Pain relievers to deal with pain symptoms, or Birth control pills: Thin the lining of the uterus, so that the uterine muscles do not need to contract as much during menstruation. At the same time, oral contraceptives also have the effect of regulating menstruation, reducing the amount of prostaglandins secreted, so menstrual cramps also become softer. Particularly for secondary dysmenorrhea, it is necessary to thoroughly treat the cause of the symptoms, to avoid affecting health in general and fertility in particular.

Primary dysmenorrhea is part of the menstrual cycle, so it has almost no effect on fertility, but if it is secondary dysmenorrhea, there is a risk that it will affect the "motherhood" function. Of the woman.
For example, for endometriosis and pelvic inflammatory disease, the possibility of scarring in the fallopian tubes, significantly affects the meeting of sperm and egg to fertilize to form a zygote.

Primary dysmenorrhea is considered a normal manifestation of a woman's body in response to hormonal changes during the menstrual cycle. However, women should see a doctor when they have unusual signs such as more pain than in previous periods, menorrhagia, or irregular periods.
In addition, women should be examined if they have symptoms of secondary dysmenorrhea.
The package of examination and screening for basic gynecological pathologies at Vinmec International General Hospital applies to women when they have problems such as:
Abnormal vaginal bleeding Having menstrual problems : irregular menstrual cycle, irregular menstrual cycle Abnormal vaginal discharge (bad smell, different color) Prolonged menstrual pain, itching in the private area. When visiting, customers will be examined:
Gynecological specialist examination Transvaginal ultrasound of the uterus and ovaries Transvaginal ultrasound of the breast bilaterally Tests such as: Treponema pallidum rapid test, Chlamydia rapid test, patient collection Cervical-vaginal cytology products, bacterioscopic staining (female vaginal fluid), HPV genotype PCR automated system, Urinalysis by automatic machine. With a team of medical - doctors who are leading experts, highly qualified, dedicated and wholeheartedly for the benefit of patients. The system of modern equipment, supporting effective diagnosis and treatment helps to detect diseases early, making treatment easy and inexpensive. Screening for early detection of gynecological cancer (cervical cancer)