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More than 85 percent of women in reproductive age experience painful menstruation. Sometimes, there may not be any associated medical condition to the monthly pain. In this case, we call it primary dysmenorrhea.

However, in other case, conditions that can cause painful menstruation include: endometriosis, Pelvic Inflammatory Disease (PID), adenomyosis, cervical stenosis, fibroid, intrauterine adhesion, Intra uterine contraceptive devices. Once there is identifiable cause, we call painful menstruation- secondary dysmenorrhea.

Patient with secondary dysmenorrhea respond minimally to even pain relieving drugs.

It is important to note that there is always an underlying cause of secondary dymmenorhea. This should be suspected in a woman who for about 1-2 years of painless menstrual flow is now having menstrual pain, if there is irregular or heavy flow with the pain, poor response to medication, vagina discharge or infertility.

If your doctor is thinking in line of secondary dysmennorhea, he/she might need to do pelvic examination for you which include:
Inspection of external genitalia (outside part of your reproductive system) for rashes, swelling and discoloration
Inspection of the vagina for discharge or blood.
Inspection of the cervix
Bimanual examination to know if there is uterine mass or adnexal tenderness

After the examination, your doctor will request for the following investigations:
High vagina swab and endocervical swab to exclude pelvic infection in particular Chlamydia trachomatis and Neisseria gonorrhea.
Abdominopelvic scan
Transvaginal ultrasound scan
Diagnostic laparoscopy


  1. Lifestyle modification: This include exercising, consumption of vegetables, low fat diet and cessation of smoking.
  2. Used of NSAIDs e.g Ibuprofen, Mefenamic acid, diclofenac etc.
  3. Use of Levonorgestrel I.U.D.
  4. Use of antibiotics where indicated
  5. Surgical intervention might be needed in some cases of secondary dysmenorrhea.