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Dysmenorrhoea is defined as painful menses and is reported by up to 50-90% of women.


It is described as primary dysmenorrhoea if no underlying cause of the pain is found and the reproductive organs and pelvis are seemingly normal. This appears to be more common in teenage women and tends to resolve with increasing age before becoming more common again closer to menopause. Other risk factors include BMI <20kg/m2, smoking, starting your periods before age 12, longer cycles and longer duration of bleeding, irregular or heavy flow, and a history of sexual assault.


Secondary dysmenorrhoea is menses pain where there is an underlying condition causing the pain. For example, this may be endometriosis, adenomyosis, fibroids or pelvic infection. However, the most common cause of secondary dysmenorrhoea is endometriosis and many cases labelled as primary dysmenorrhoea are probably cases of undiagnosed endometriosis.


Endometriosis is a common condition affecting around 8% per cent of the female population.


It is caused by the lining of the womb (endometrium) appearing in other places in the body. Most commonly endometriosis occurs inside the pelvic area and attaches to the ovaries, the ligaments behind the womb, the tissue layer lining the pelvis (peritoneum), the bladder and ureters or the intestine. When it causes cysts on the ovaries these are called endometriomas or “chocolate cysts” because they are filled with a chocolate-like liquid consisting of old blood. When the cysts are bilateral and meet together in the midline they are described as "kissing ovaries".


Endometriosis can occur in minimal amounts (stage 1) through to severe amounts (stage 4). The cause of endometriosis is still unknown. Adenomyosis is endometriosis in the muscle layer of the womb itself.


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