SA Review of Etiopathological Risk Factors of Dysmenorrhea in Unani and Contemporary Medical Literature

Dysmenorrhea, or painful menstruation, is one of the most common gynecological complaints among adolescent and reproductive-age women. In Unani medicine, the condition is described as Usr al-Tamth, characterized by painful and often scanty menstrual flow. Objective: The present review aims to critically analyze the Etiopathological mechanisms and associated risk factors of dysmenorrhea from classical Unani and contemporary biomedical perspectives, and to highlight the relevance of an integrative approach in its understanding and management. Methodology: A comprehensive literature review was conducted using classical Unani texts and contemporary biomedical databases, including peer- reviewed articles published between 2000-2025. Relevant information was systematically collected, analyzed, and synthesized to identify key etiological factors, pathophysiological mechanisms, and associated risk factors of dysmenorrhea. Both qualitative descriptions from Unani literature and evidence from modern clinical and epidemiological studies were integrated. Primary dysmenorrhea, which occurs in the absence of identifiable pelvic pathology and is mainly associated with increased production of prostaglandins, leading to uterine hypercontractility and pain. Secondary dysmenorrhea, on the other hand, results from underlying gynecological condition such as endometriosis, adenomyosis, and pelvic inflammatory disease, all of which result in structural or pathological alterations within the reproductive system, thereby contributing to more severe and persistent menstrual pain. A synthesis of contemporary literature highlights a range of biological, lifestyle, psychological, and socio-environmental risk factors associated with dysmenorrhea, including early menarche, family history, obesity, smoking, unhealthy dietary patterns, physical inactivity, psychological stress and low socioeconomic status. From an Unani perspective, dysmenorrhea is attributed to Su-i-Mizaj (abnormal temperament), Ghalaba'-i-Akhlat(humoral imbalance), Sudda (obstruction) and disturbance in Asbab Sitta Daruriyya (the six essential lifestyle factors). This review emphasizes the importance of integrative approach that combine traditional Unani concepts with modern scientific understanding to improve the prevention, diagnosis, and management of dysmenorrhea.