Dysmenorrhea

A 28-year-old woman from Mumbai presents with severe dysmenorrhea that has progressively worsened over the past 3 years. She reports that menstrual pain now begins 5–7 days before her period, peaks during menstruation, and may persist for 1–2 days after bleeding stops. She describes the pain as deep, aching, and diffuse across the lower abdomen and pelvis. She also reports dyspareunia (pain during intercourse), chronic pelvic pain between periods, and has been unable to conceive despite 2 years of unprotected intercourse. On pelvic examination, the uterus is slightly enlarged, tender, and fixed. Transvaginal ultrasound shows a heterogeneous endometrial echotexture with poor definition of the endometrial–myometrial interface. What is the most likely diagnosis?

A 22-year-old unmarried woman from Delhi presents with severe lower abdominal cramping pain that begins 1 day before her menstrual flow and lasts 2–3 days into menstruation. The pain is colicky in nature, radiates to the lower back and inner thighs, and is accompanied by nausea, vomiting, and occasional diarrhoea. She reports that the pain significantly interferes with her daily activities and school attendance. On general examination, she appears anxious and in distress during the interview. Abdominal and pelvic examination reveal no masses, tenderness, or abnormality. Transvaginal ultrasound is normal. She has never been pregnant and has no history of pelvic infection or endometriosis. What is the most likely diagnosis?

Which of the following prostaglandins is primarily responsible for the pathophysiology of primary dysmenorrhea?

Which of the following mechanisms explains why NSAIDs are effective in treating primary dysmenorrhea?