Dysmenorrhea (aka painful periods) is pain during mensturation, that interferes with daily activities, or at least excessive.

• Pain can be sharp, throbbing, dull, nauseating, burning, or shooting pain. The pain is usually in the pelvis or lower abdomen
• Back pain
• Diarrhea
• Nausea
• It usually begins around the time that menstruation begins, or may precede menstruation by several days
• Sx typically last <3 days
• Usually subsides as menstruation tapers off

• Menstrual pain can be normal, with no underlying problem, especially in young women
• In older women, it is more often due to an underying condition, including:
  • Uterine fibroid
  • Adenomyosis
  • Endometriosis

• Menorrhagia (heavy periods)
• Irregular periods
• Periods started <12yo
• Low body weight

• Secondary dysmenorrhea is when there is an underlying disease, disorder, or structural abnormality (within or outside the uterus)
• Primary dysmenorrhea is Dx by exclusion [of underlying disease]

• Ectopic pregnancy
• PID
• Interstitial cystitis
• Chronic pelvic pain

• Pelvic exam, in patients who are sexually active
• U/S

• Menorrhagia (heavy blood loss)

• It is only concerning if excessive, or more importantly, interferes with daily activities

• Menstrual cramps, which refers to uterine contractions
• Menorrhagia (heavy bleeding)