Gå direkt till huvudinnehållet

Primär dysmenorré

Senast uppdaterad: Senast reviderad:
Sakkunnig:


Definition:
Menstruationssmärtor utan patologiska fynd. Ihållande kontraktioner som utlöses av prostaglandiner och som leder till hypoxi i uterusmuskulaturen orsakar smärtorna.
Förekomst:
Vanligt bland unga kvinnor. Förbättras med tiden.
Symtom:
Smärtorna är krampliknande och sitter lågt i magen, lokaliserade till mittlinjen. Ofta utstrålning mot ryggen och insidan av låren, eventuellt illamående, kräkningar och diarré. Smärtorna börjar ofta några timmar innan blödningen startar och avtar vanligen efter ett dygn.
Kliniska fynd:
Normalt kliniskt status.
Diagnostik:
Typisk anamnes och normalt kliniskt statusTilläggsundersökningar behövs oftast inte.
Behandling:
NSAID eller p-piller.
  1. French L. Dysmenorrhea. Am Fam Physician 2005; 71: 285-91. American Family Physician  
  2. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ 2006; 332: 1134-8. PubMed  
  3. Davis AR, Westhoff CL. Primary dysmenorrhea in adolescent girls and treatment with oral contraceptives. J Pediatr Adolesc Gynecol 2001; 14: 3-8. PubMed  
  4. Banikarim C, Chacko MR, Kelder SH. Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatr Adolesc Med 2000; 154: 1226-9. PubMed  
  5. Strinic T, Bukovic D, Pavelic L, Fajdic J, Herman I, Stipic I, et al. Anthropological and clinical characteristics in adolescent women with dysmenorrhea. Coll Antropol 2003; 27: 707-11. PubMed  
  6. Teperi J, Rimpela M. Menstrual pain, health and behaviour in girls. Soc Sci Med 1989; 29: 163-9. PubMed  
  7. Andersch B, Milsom I. An epidemiologic study of young women with dysmenorrhea. Am J Obstet Gynecol 1982; 144: 655-60. PubMed  
  8. Klein JR, Litt IF. Epidemiology of adolescent dysmenorrhea. Pediatrics 1981; 68: 661-4. Pediatrics  
  9. Sundell G, Milsom I, Andersch B. Factors influencing the prevalence and severity of dysmenorrhoea in young women. Br J Obstet Gynaecol 1990; 97: 588-94. PubMed  
  10. Moen MH, Stokstad T. A long-term follow-up study of women with asymptomatic endometriosis diagnosed incidentally at sterilization. Fertil Steril 2002; 78: 773-6. PubMed  
  11. Momoeda M, Taketani Y, Terakawa N, Hoshiai H, Tanaka K, Tsutsumi O, et al. Is endometriosis really associated with pain? Gynecol Obstet Invest 2002; 54(suppl 1): 18-21.
  12. Latthe P, Mignini L, Gray R, et al. Factors predisposing women to chronic pelvic pain: systematic review. BMJ 2006; 332: 749. pmid:16484239 PubMed  
  13. Moore J, Copley S, Morris J, Lindsell D, Golding S, Kennedy S. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound Obstet Gynecol 2002; 20: 630-4. PubMed  
  14. Marjoribanks J, Ayeleke RO, Farquhar C, et al. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2015 Jul 30;7:CD001751. Cochrane (DOI)  
  15. Weaver AL. Rofecoxib: clinical pharmacology and clinical experience. Clin Ther 2001; 23: 1323-38. PubMed  
  16. Hendrix SL, Alexander NJ. Primary dysmenorrhea treatment with a desogestrel-containing low-dose oral contraceptive. Contraception 2002; 66: 393-9. PubMed  
  17. Milsom I, Sundell G, Andersch B. The influence of different combined oral contraceptives on the prevalence and severity of dysmenorrhea. Contraception 1990; 42: 497-506. PubMed  
  18. Davis AR, Westhoff C, O'Connell K, Gallagher N. Oral contraceptives for dysmenorrhea in adolescent girls: a randomized trial. Obstetrics & Gynecology 2005; 106: 97-104.
  19. Wong CL, Farguhar C, Roberts H, Proctor M. Oral contracptive pills as treatment for primary dysmenorrheal. Cochrane Database Syst Rev 2009 The Cochrane Library  
  20. Archer DF. Menstrual-cycle-related symptoms: a review of the rationale for continous use of oral contaceptives. Contraception 2006 nov 74(5) 359-66
  21. Audet MC, Moreau M, Koltun WD, Waldbaum AS, Shangold G, Fisher AC, et al. Evaluation of contraceptive efficacy and cycle control of a transdermal contraceptive patch vs an oral contraceptive: a randomized controlled trial. JAMA 2001; 285: 2347-54. Journal of the American Medical Association  
  22. Baldaszti E, Wimmer-Puchinger B, Loschke K. Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system (Mirena): a 3-year follow-up study. Contraception 2003; 67: 87-91. PubMed  
  23. Wildemeersch D, Schacht E, Wildemeersch P. Treatment of primary and secondary dysmenorrhea with a novel 'frameless' intrauterine levonorgestrel-releasing drug delivery system: a pilot study. Eur J Contracept Reprod Health Care 2001; 6: 192-8. PubMed  
  24. Dawood MY, Ramos J. Transcutaneous electrical nerve stimulation (TENS) for the treatment of primary dysmenorrhea: a randomized crossover comparison with placebo TENS and ibuprofen. Obstet Gynecol 1990; 75: 656-60. PubMed  
  25. Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database Syst Rev 2002; 3. The Cochrane Library  
  26. Akin M, Price W, Rodriguez G Jr, Erasala G, Hurley G, Smith RP. Continuous, low-level, topical heat wrap therapy as compared to acetaminophen for primary dysmenorrhea. J Reproductive Med 2004; 49: 739-45. PubMed  
  27. Matthewman G, Lee A, Kaur JG, Daley AJ. Physical activity for primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol 2018; 219: 255. pmid:29630882 PubMed  
  28. Armour M, Ee CC, Naidoo D, et al. Exercise for dysmenorrhoea. Cochrane Database Syst Rev. 2019 Sep 20;9:CD004142. doi: 10.1002/14651858.CD004142.pub4. The Cochrane Library  
  29. Träning för att lindra primär dysmenorré. SBU-rapport 2020, hämtad 2020-03-26 www.sbu.se  
  30. Helms JM. Acupuncture for the management of primary dysmenorrhea. Obstet Gynecol 1987; 69: 51-6. PubMed  
  31. Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev 2016; 3: CD002124. doi:10.1002/14651858.CD002124.pub2 DOI  
  32. Proctor M, Hing W, Johnson T, Murphy P. Spinal manipulation for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2004; 3. The Cochrane Library  
  • Barbro Larson, docent och specialist i gynekologi och obstetrik, Stockholm
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet