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Primary dysmenorrhea results from contractions of the uterus. The uterus is an organ lined with muscle layers that contract and relax. During menses, the contractions are stronger and cause pain. These contractions are stimulated by pain-triggering hormones called prostaglandins. The level of prostaglandins increases just before the cycle's start and then drops off with the onset of the menstrual flow.
The variation in prostaglandin levels is directly related to the duration of pain. In fact, the pain starts with menses, peaks during the first 2 days, then subsides and disappears as the cycle progresses.

Other factors that can cause or heighten primary dysmenorrhea are:

  • Excess weight. Overweight women have stronger and more persistent menstrual pain.
  • Smoking. Women smokers are 50% more likely to suffer from menstrual pain.
  • Alcohol consumption. Alcohol consumption prolongs the duration of pain in women who suffer from dysmenorrhea.
  • Sedentary lifestyle and stress. Stress and lack of regular physical exercise increase menstrual pain.

Secondary dysmenorrhea is caused by certain disorders of the female reproductive system. The most common ones are:

  • Endometriosis. The tissue lining the uterus, called endometrium, can sometimes reside outside the uterine cavity (ovaries, Fallopian tubes, etc.). The endometrium is responsible for menstruation. Even when present in other nearby areas, endometrial tissue still acts as it does inside the uterus. This means it responds to hormonal changes, breaks apart and bleeds. This is what causes the pain.
  • Fibromas. These benign tumors form and grow in the uterus or the ovaries. They cause pain during the menstrual flow.
  • Pelvic inflammatory disease (PID). A bacterial infection of the uterus, Fallopian tubes and ovaries.

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