A practical approach to the patient with dysmenorrhea.

Pelvic pain associated with the menses may be a result of physiologic problems, premenstrual tension syndrome, primary dysmenorrhea or secondary dysmenorrhea. All of these conditions may be caused by both physiologic and psychologic factors. An accurate diagnosis requies a complete history and physical examination and astute assessment of predisposing or aggravating conditions. Diagnosis has been improved through the use of laparoscopy, hysteroscopy, hysterosalpingography and dilatation and curettage. Treatment has been revolutionized with the use of oral contraceptives and prostaglandin synthesis inhibitors. These diagnostic and therapeutic advances now enable the sympathetic physician to effectively evaluate and treat almost all patients with menstrually related pelvic pain. When all of these approaches fail, the physician should consider psychiatric consultation or referral to pain clinic or gynecologist with special interest in this field.