Snap Shot An 18-year-old nulligravid college woman complains of painful menses for the past three years. These symptoms are associated with cramping located in her lower abdomen that radiate to her lower back and inner thighs. She has nausea and vomiting. Pelvic exam is normal. Introduction Abdominal pain with menses May result from primary or secondary causes primary excessive prostaglandin-induced myometrial contractions ↑ PGF2α secondary endometriosis adenomyosis leiomyomas Treatment Medical (for primary type) ibuprofen/NSAID OCP nifedipine