Menstrual Pain (Dysmenorrhea): Causes

Pathogenesis (development of disease)

One can distinguish various factors in the pathogenesis of dysmenorrhea. These include psychological (such as stressful situations) and social factors (social status) as well as hormonal influences. These are prostaglandins (group of tissue hormones), but also leukotrienes, oxytocin or vasopressin. Probably the triggering factor of dysmenorrhea is an overproduction of prostaglandins, which leads to painful contractions of the uterine musculature (uterine muscles). Premenstrual dysphoric disorder (PMDS), a variant of premenstrual syndrome (PMS), is caused by genetic hypersensitivity to sex hormones.

Etiology (Causes)

Primary dysmenorrhea

Biographic causes

  • Anatomic malpositions of the uterus (uterine; e.g., retroverted uterus (“tilted backward” uterus))
  • Lower uterine anomalies (malformations of the uterus) (approximately 10% of cases):
    • Uterus arcuatus (lat. arcuatus “bent”) – slightest expression of the uterus septus (see below).
    • Uterus bicornis (partial fusion of the Müller ducts): this conditions a common cervix (cervix) with uterine horns separated to varying degrees.
    • Uterus didelphys (lack of fusion of the two Müller ducts): this conditions a duplicity of corpus uteri (uterine body) and cervix uteri.
    • Uterine septum (complete fusion of the Müller ducts with incomplete resorption of the middle septum, which results in a varying length and shape of the septum (septum); most common uterine malformation): This results in an externally normal-shaped uterus with an externally broadly expansive smooth fundus (broad part of the uterus lying between the tubal openings) with sagittal median septum. Three forms can be distinguished according to the length of the septum:
      • Uterus subseptus (septum extends into the cavum/uterine cavity).
      • Uterus septus (septum extends to the cervix).
      • Uterus septus completus (septum extends into the cervix).
    • Uterus unicornis (maldevelopment in a Müller duct): this may result in the presence of a rudimentary horn.

Behavioral causes

  • Psycho-social situation
    • Psychological conflicts

Secondary dysmenorrhea

Behavioral causes

Disease-related causes

Neoplasms – tumor diseases (C00-D48).

Psyche – nervous system (F00-F99; G00-G99)

  • Pelvipathy – lower abdominal pain in women due to very different causes, which may be somatic (physical) as well as psychological.
    • Pelvipathia vegetativa (synonyms: parametropathia spastica, pelvic congestion) – vegetative dystonia (disorder of conduction in the nervous system) with manifestation in the pelvis in vegetative lability (susceptibility to stress).
    • Mittelschmerz (pain at the time of ovulation / ovulation).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).

Other causes

  • Cervical stenosis (narrowing of the cervix).
  • Genital hypoplasia (uterine hypoplasia/underdevelopment of the uterus).
  • Hymen imperforatus (“intact hymen”).
  • Intrauterine device (IUD, coil)