Dysmenorrhea affects over 50% of menstruating women and causes extensive personal and public health problems, a high degree of absenteeism and severe economic loss. In primary dysmenorrhea there is no macroscopically identifiable pelvic pathology, while in secondary dysmenorrhea gross pathology is present in the pelvic structures. With primary dysmenorrhea the pain is suprapubic and spasmodic, and associated symptoms may be present. Characteristically dysmenorrhea starts at or shortly after menarche. The pain lasts for 48-72 hours during the menstrual flow and is most severe during the first or second day of menstruation. It is now clear that in many women with primary dysmenorrhea the pathophysiology is due to increased and/or abnormal uterine activity because of the excessive production and release of uterine prostaglandins. Treatment with many of the prostaglandin synthetase inhibitors (nonsteroidal antiinflammatory drugs) will produce significant relief from dysmenorrhea and a concomitant decrease in menstrual fluid prostaglandins. For dysmenorrheic women who desire oral contraception, this agent will relieve the dysmenorrhea by suppressing endometrial growth, thus resulting in a decrease in the menstrual flow as well as in menstrual fluid prostaglandins. For those not requiring oral contraception the drug of choice for primary dysmenorrhea remains a prostaglandin inhibitor. Laparoscopy need be resorted to only if a pelvic abnormality is detected on examination or if treatment with prostaglandin inhibitors for up to six months is not significantly effective. In secondary dysmenorrhea, relief is obtained when the pelvic pathology--such as ovarian cysts, uterine fibroids, adhesions, cervical stenosis, congenital malformation of the uterus and endometriosis--is treated. In women using IUDs the dysmenorrhea is readily controlled with prostaglandin inhibitors since the underlying pathophysiology is excessive prostaglandin production and release.
痛经影响超过50%的经期女性，导致广泛的个人和公共卫生问题、高缺勤率及严重的经济损失。原发性痛经时，盆腔无宏观可识别的病理改变，而继发性痛经时盆腔结构存在明显病理改变。原发性痛经的疼痛位于耻骨上且呈痉挛性，可能伴有相关症状。痛经的典型特征是初潮时或初潮后不久开始。疼痛在月经期间持续48 - 72小时，在月经的第一天或第二天最为严重。现在很清楚，许多原发性痛经女性的病理生理机制是由于子宫前列腺素过度产生和释放导致子宫活动增加和/或异常。使用许多前列腺素合成酶抑制剂（非甾体抗炎药）治疗可显著缓解痛经，并使月经血中前列腺素同时减少。对于希望采用口服避孕药的痛经女性，该药物通过抑制子宫内膜生长来缓解痛经，从而导致月经量及月经血中前列腺素减少。对于那些不需要口服避孕药的女性，原发性痛经的首选药物仍然是前列腺素抑制剂。仅在检查发现盆腔异常或使用前列腺素抑制剂治疗长达六个月效果不显著时才需要进行腹腔镜检查。在继发性痛经中，治疗盆腔病变（如卵巢囊肿、子宫肌瘤、粘连、宫颈狭窄、子宫先天性畸形和子宫内膜异位症）后可缓解痛经。对于使用宫内节育器的女性，由于潜在的病理生理机制是前列腺素过度产生和释放，痛经很容易用前列腺素抑制剂控制。
