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Psychogenic dysmenorrhea — Clinical Guidelines

Overview

Psychogenic dysmenorrhea refers to menstrual pain without an identifiable organic cause, often exacerbated by psychological factors such as stress and anxiety, significantly impacting quality of life 1.

Diagnosis

Clinical diagnosis based on history and exclusion of secondary causes 1 4.

No specific diagnostic tests; pelvic examination and imaging may be used to rule out organic pathology 3.

Grading systems often rely on pain intensity scales (e.g., visual analogue scale) 8.

Management

First-line treatments:

- Nonsteroidal anti-inflammatory drugs (NSAIDs): Ketoprofen (100 mg) and naproxen (500 mg) show efficacy with rapid onset of pain relief 8 12. - Vitamin D supplementation: Emerging evidence suggests potential benefits, particularly in adolescents 3.

Adjunctive treatments:

- Yoga: Holistic approach shown to alleviate both physical and psychological symptoms 1. - Acupoint injection with vitamin K (phylloquinone): Substantial plasma concentration increases observed, though further clinical trials needed 6. - Vitamin E and D combination: Mixed results; requires larger trials for definitive efficacy 2.

Special Populations

Adolescents: Vitamin D supplementation may be particularly beneficial due to its role in inflammatory modulation 3.

Pregnancy: Not specifically addressed in abstracts; NSAIDs generally contraindicated 9.

Elderly: Limited data; management similar to general population with caution on NSAID use due to comorbidities 9.

Comorbidities: No specific recommendations; focus on managing pain and underlying conditions concurrently 9.

Key Recommendations

Use NSAIDs (e.g., naproxen 500 mg, ketoprofen 100 mg) for rapid pain relief in primary dysmenorrhea (Evidence: Strong 8 12).

Consider vitamin D supplementation, especially in adolescent populations, to potentially reduce dysmenorrhea symptoms (Evidence: Moderate 3).

Incorporate mind-body interventions like yoga to address both physical and psychological aspects of dysmenorrhea (Evidence: Moderate 1).

Evaluate and rule out organic causes through clinical examination and imaging before attributing dysmenorrhea to psychogenic factors (Evidence: Expert opinion 3).

References

1 Shetty DP, Patil NJ, Shyamala G, Belle VS, Annapoorna K, Ghosh M. Effectiveness of Yoga-A Mind-Body Intervention for Pain and Stress Associated with Primary Dysmenorrhea: A Narrative Review. Advances in mind-body medicine 2025. link 2 Hosseini MS, Talayeh M, Haghbin Toutounchi A, Hosseini A, Moradi N, Iranshahi S et al.. Effect of vitamin D and E supplementation on pain relief and premenstrual symptoms in primary dysmenorrhea: a randomized controlled trial. BMC women's health 2025. link 3 Donayeva A, Amanzholkyzy A, Abdelazim I, Kurmangazin M, Khamidullina Z, Kurmanalina M et al.. The effect of vitamin D on adolescents' primary dysmenorrhea. Journal of medicine and life 2023. link 4 Payne LA, Seidman LC, Sim MS, Rapkin AJ, Naliboff BD, Zeltzer LK. Experimental evaluation of central pain processes in young women with primary dysmenorrhea. Pain 2019. link 5 Seidman LC, Brennan KM, Rapkin AJ, Payne LA. Rates of Anovulation in Adolescents and Young Adults with Moderate to Severe Primary Dysmenorrhea and Those without Primary Dysmenorrhea. Journal of pediatric and adolescent gynecology 2018. link 6 Chao MT, Wade CM, Booth SL. Increase in plasma phylloquinone concentrations following acupoint injection for the treatment of primary dysmenorrhea. Journal of acupuncture and meridian studies 2014. link 7 Brinkert W, Dimcevski G, Arendt-Nielsen L, Drewes AM, Wilder-Smith OHG. Dysmenorrhoea is associated with hypersensitivity in the sigmoid colon and rectum. Pain 2007. link 8 Akerlund M, Strömberg P. Comparison of ketoprofen and naproxen in the treatment of dysmenorrhoea, with special regard to the time of onset of pain relief. Current medical research and opinion 1989. link 9 Visner SL, Blake RL. Physician's knowledge and treatment of primary dysmenorrhea. The Journal of family practice 1985. link 10 Hanson FW. Naproxen sodium, ibuprofen and a placebo in dysmenorrhea. The Journal of reproductive medicine 1982. link 11 Forman A, Anderson KE, Ulmsten U. Combined effects of diflunisal and nifedipine on uterine contractility in dysmenorrhoeic patients. Prostaglandins 1982. link90051-x) 12 Hamann GO. Severe, primary dysmenorrhea treated with naproxen. A prospective, double-blind, crossover investigation. Prostaglandins 1980. link90164-1) 13 Bergsjø P. Socioeconomic implications of dysmenorrhea. Acta obstetricia et gynecologica Scandinavica. Supplement 1979. link 14 Bergsjo P, Jenssen H, Vellar OD. Dysmenorrhea in industrial workers. Acta obstetricia et gynecologica Scandinavica 1975. link

Psychogenic dysmenorrhea