Which condition primarily causes dysmenorrhea in women?

Dysmenorrhea, or painful menstruation, is primarily associated with excess production of prostaglandin F2 alpha. Prostaglandins are lipid compounds that play a vital role in the contraction of uterine muscles during menstruation. An increase in prostaglandin levels leads to heightened uterine contractions, which can result in increased pain and cramping, characteristic of dysmenorrhea.

While conditions like endometriosis, uterine fibroids, and pelvic inflammatory disease can certainly contribute to menstrual pain, they are generally considered secondary causes of dysmenorrhea. Endometriosis involves the presence of endometrial-like tissue outside the uterus, fibroids are benign tumors of the uterine muscle, and pelvic inflammatory disease is an infection of the reproductive organs. All of these conditions can cause pelvic pain and dysmenorrhea, but the primary mechanism for typical dysmenorrhea is linked to the excessive prostaglandin production. This underscores the role of prostaglandins as a central factor in the most common form of dysmenorrhea experienced by women.