Primary dysmenorrhoea is painful menstruation with no detectable organic disease. The pain in this condition is thought to result from uterine contractions, probably associated with uterine muscle ischemia and Prostaglandin's produced by the uterus. Prostaglandins are known to stimulate uterine contractions, but they cannot do so in the presence of high levels of progesterone (a hormone secreted by ovary). Progesterone levels are high during the last half of the menstrual cycle, and during this time Prostaglandin's are apparently inhibited by progesterone from producing uterine contractions. However, in the absence of pregnancy progesterone levels drop rapidly and prostaglandin production increases. This causes the uterus to contract and slough off its lining, which may result in dysmenorrhoea. In addition to pain, other signs and symptoms may include headache, nausea, diarrhoea or constipation and increased urinary frequency. Secondary dysmenorrhoea is painful menstruation that is frequently associated with a pelvic pathology.

In some cases it is caused by uterine tumours, ovarian cysts, pelvic inflammatory disease, endometriosis and intrauterine devices.
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