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Dysmenorrhea, or painful uterine contractions during menstruation in women, is a common condition. It may affect up to 90% of patients in a doctor's office. Depending on the severity of symptoms, it may cause discomfort or prevent normal functioning in everyday life. Some women do not realize that this is not a normal symptom during menstruation. Unfortunately, lack of exercise, smoking, or drinking alcohol only increases the symptoms. A medical history and physical examination of the patient are important steps in finding the cause. Primary dysmenorrhea is primarily associated with the pathogenesis of prostaglandins and leukotrienes, which generate inflammation and pain. However, it has nothing to do with pelvic pathology. It usually first appears in young women during puberty, up to 24 months after their first period. If the history and physical examination are not clear about the primary cause of pain, a secondary cause should be considered. For this purpose, a transvaginal ultrasound examination should be performed. The most common secondary pathology is endometriosis. In the treatment of primary and secondary diseases, physical exercises and warm compresses are beneficial, which women are often unaware of. First-line pharmacological treatment may include NSAIDs or combined oral estrogen-progestogen hormonal therapy. The purpose of this review is to provide knowledge about the symptoms, risk factors, diagnosis, and treatment of dysmenorrhea.

The aim of this systematic review was to identify the current state of knowledge on the association between susceptibility genes associated with this disorder and the lifestyle of patients (including diet, habits and stress levels). It also highlighted the advances made in this field of study, from a constructive point of view, and pointed out the perspectives for research into this disorder. Dysmenorrhoea, as a primary and secondary disorder, is one of the main causes of partial or total disability in the life cycle of women, both in reproductive age and later. It is recognised as a painful and disabling disorder which, depending on the cultural context, may or may not be cured by medical care, physiotherapy and the use of pain-relieving drugs, from an unknown aetiology (primary dysmenorrhoea) or concomitantly to surgical intervention (secondary dysmenorrhoea). Lifestyle, habits and diet have been identified as related to the intensity of pain and the disability it causes (active or passive use of cigarettes, consumption of alcohol, etc.), and genes related to the interpretation of pain generated by the patient from the morphology of the hypothalamus and the associative function of pain (BNDF Val66Met polymorphism) have been identified, as well as alterations in cytokines (in primary dysmenorrhoea), prostaglandins and an influence of the Cyp1A1 gene (in passive smokers). The study perspective is usually non-integrative and limited to the site studied, as well as to professional, laboratory, imaging (gynaecological and genetic) and/or molecular resources, which can only in a few cases be of an integral approach. Limitations are compounded by the fact that not all the populations studied are usually educated about menstruation, which also limits compatibility and comparability among studies.

The World Health Organization estimates dysmenorrhea as the most important cause of a chronic pelvic pain. Its prevalence among adolescents and young women ranges from 40 % to 90 %, and varies, depending on age, country of residence and population density of the area. Primary dysmenorrhea is responsible for reducing the quality of life, absenteeism in the workplace or at school, refusing to participate in community and sporting events, changing of pain perception and sleep disturbance. There is evidence of its relationship with an early menarche, a family history, a length of the menstrual cycle, bad habits, poor sleep hygiene, an unbalanced diet, sedentary lifestyle and obesity. Characteristic features of a personality contribute in a certain way, making women prone to neuroticism and pain catastrophizing to be more at risk of developing dysmenorrhea. Irritable bowel syndrome, musculoskeletal pain and interstitial cystitis often accompany dysmenorrhea and respond to its treatment positively. Despite the proven validity of nonsteroidal anti­inflammatory drugs treatment there are resistant forms of menstrual pain, those make a search for alternative therapy relevant.

Abstract Background The unicornuate uterus is caused by abnormal or failed development of one Müllerian duct. Unicornuate uteri with functioning non-communicating rudimentary horns are susceptible to many gynaecologic and obstetric complications such as hematometra, endometriosis and ectopic pregnancy and thus surgical resection is usually recommended.. Case presentation We report a rare case of a unicornuate right uterus with rudimentary non-communicating (functional) cavitary left horn (class U4a) in a 17-year-old girl who was diagnosed with VACTERL association. She was presented to our centre with 3 years history of secondary sever dysmenorrhea. Pelvic magnetic resonance imaging revealed a normal uterus on the right side, a 7 × 8 cm left endometrioma, a tortuous dilated fluid-filled structure in the left hemipelvis, mostly represented left-sided hematosalpinx, and a well-defined lesion with thick enhancing wall in the left hemipelvis measuring 6.7 × 5.7 × 5.6 cm with a similar enhancement to the uterus in the right. She underwent laparotomy that showed a right unicornuate uterus with a normal cervix and a rudimentary non-communicating distended left horn. In addition, there was a left endometrioma and left hematosalpinx. Resection of the left communicating horn, left salpingectomy and left ovarian cystectomy were performed. The right tube and both ovaries were preserved. At 9-months follow up, the patient had a regular period and the pain subsided completely. Conclusion We report yet the second case of VACTERL association and unicornuate uterus with non-communicating functional rudimentary horn, in hope of expanding the knowledge of a rare occurrence. This case also highlights the importance of considering the diagnosis of Müllerian duct anomalies in patients with a history of other anomalies, and/or history of early-age secondary dysmenorrhea.