TENS in the Treatment of Primary Dysmenorrhea
by Howard Smith, MD and Vian Younan, MD
 Dysmenorrhea is the occurrence of painful uterine cramps during
menses and is the most common of all gynecologic complaints. Dysmenorrhea is divided into
primary and secondary forms. Primary dysmenorrhea has no known pelvic pathologic etiology.
Whereas secondary dysmenorrhea is related to the presence of pelvic lesions secondary to
organic disease such as endometriosis, salpingitis, PID (pelvic inflammatory disease),
adhesions, etc.1
Characteristically, primary dysmenorrhea starts shortly after menarche. The pain lasts
for 48-72 hours of menstruation and is most severe during the first or second day of the
menstrual cycle. Reported prevalence rates are as high as 90 percent.2 It is
the leading cause of absenteeism of women from work, school, and other activities.3,4
A recent study of young Hispanic adolescent females showed that menstrual pain was
significantly associated with school absenteeism and decreased academic performance,
sports participation, and socialization with peers.5
In fact, 42 million women in the United States suffer from painful menstrual symptoms.
Of these, about 3.5 million are unable to function for one to two days each month because
the condition is so severe. In an older study, the economic implications were clearly
presented — dysmenorrhea accounted for 600 million lost work hours and $2 billion in
lost productivity annually.6
Women with primary dysmenorrhea have increased production of endometrial prostaglandin,
resulting in increased uterine tone and stronger, more frequent uterine contractions.
Majority of prostaglandins are released during the first 48 hours of menstruation, thus
explaining the timing and limitation of symptoms. Prostaglandins stimulate an increase in
myometrial muscle tone and contractions, and release of vasopressin in uterine blood
vessels which may result in ischemic pain and other associated symptoms.1
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— Nov/Dec 2003
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