Contents: Clinical Expert SeriesPrimary Dysmenorrhea Diagnosis and TherapyFerries-Rowe, Elizabeth MD, MA; Corey, Elizabeth MD, MPH; Archer, Johanna S. VMD, MD Author Information Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana. Corresponding author: Elizabeth Ferries-Rowe, MD, MA, Department of Obstetrics and Gynecology, Indianapolis University School of Medicine, Indianapolis, IN; email: [email protected]. Financial Disclosure The authors did not report any potential conflicts of interest. Each author has confirmed compliance with the journal's requirements for authorship. Peer reviews and author correspondence are available at https://links.lww.com/AOG/C65. Obstetrics & Gynecology 136(5):p 1047-1058, November 2020. | DOI: 10.1097/AOG.0000000000004096 Buy SDC Metrics AbstractIn Brief Primary dysmenorrhea is defined as pain during the menstrual cycle in the absence of an identifiable cause. It is one of the most common causes of pelvic pain in women. Dysmenorrhea can negatively affect a woman's quality of life and interfere with daily activities. The pathophysiology of primary dysmenorrhea is likely a result of the cyclooxygenase pathway producing increased prostanoids, particularly prostaglandins (PGs). The increased PGs cause uterine contractions that restrict blood flow and lead to the production of anaerobic metabolites that stimulate pain receptors. Women with a history typical for primary dysmenorrhea can initiate empiric treatment without additional testing. Shared decision making is key to effective management of dysmenorrhea to maximize patient compliance and satisfaction. After a discussion of their risks and benefits, extremely effective empiric therapies are nonsteroidal antiinflammatory drugs and contraceptive hormonal therapy. Other treatments for primary dysmenorrhea can be employed solely or in combination with other modalities, but the literature supporting their use is not as convincing. The physician should initiate an evaluation for secondary dysmenorrhea if the patient does not report improved symptomatology after being compliant with their medical regimen. Understanding of diagnosis, pathophysiology, and all treatment options of primary dysmenorrhea can significantly improve quality of life. © 2020 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.