The etiology of primary dysmenorrhea is not precisely understood, but most symptoms can be explained by the action of uterine prostaglandins, particularly PGF2alpha. During endometrial sloughing, the disintegrating endometrial cells release PGF2alpha.
PGF2 alpha stimulates myometrial contractions, ischemia and sensitization of nerve endings. Women who have more severe dysmenorrhea have higher levels of PGF2alpha in their menstrual fluid. These levels are highest during the first two days of menses, when symptoms peak. In addition, the impressive efficacy of Non steriodal Anti Inflammatory Drugs (NSAIDS), which act through prostaglandin synthetase inhibition support this theory.
Prostaglandins are responsible for the pain and explain the response to NSAIDS
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