Dysmenorrhea ICD-10: Coding Guidance for Women’s Health Care

Menstrual pain is one of the most common gynecologic concerns affecting women across the lifespan. For many patients, these symptoms go beyond discomfort—interfering with work, daily activities, and participation in care. When that happens, accurate documentation and the use of dysmenorrhea ICD-10 coding become more than administrative steps; they become part of delivering effective, coordinated women’s health care.

In this article, we walk through how dysmenorrhea ICD-10 is applied in clinical practice, including how dysmenorrhea is classified in ICD-10, why the distinction between primary and secondary forms matters clinically, and how thoughtful documentation supports accurate coding. You’ll also see how these principles apply in a real-world women’s health scenario.

Understanding dysmenorrhea in women’s health care

Dysmenorrhea refers to painful menstruation associated with uterine cramping and may include symptoms such as low back pain, pelvic pressure, nausea, headaches, or fatigue. Symptoms typically begin shortly before or at the onset of menses and may last several days.

Clinically, dysmenorrhea is grouped into two main categories:¹

• Primary dysmenorrhea involves menstrual pain without identifiable pelvic pathology. It often begins in adolescence and is associated with prostaglandin-mediated uterine contractions.

• Secondary dysmenorrhea is linked to underlying conditions such as endometriosis, adenomyosis, uterine fibroids, or pelvic inflammatory disease.

This distinction matters not only for treatment planning but also for diagnosis coding. When pain reflects an underlying condition, ICD-10 selection must capture both the dysmenorrhea and its cause to accurately represent the patient’s clinical picture.

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Dysmenorrhea ICD-10 codes: primary and secondary options

The ICD-10-CM classification includes several codes under the N94 category that apply to dysmenorrhea. Selecting the most appropriate code depends on the clinical presentation and documentation available.

N94.4 – Primary dysmenorrhea

This code is used when menstrual pain occurs without a documented pelvic disorder. It is commonly applied in younger patients or when symptoms are long-standing and cyclical without structural findings.

N94.5 – Secondary dysmenorrhea

This code applies when menstrual pain is attributed to an identifiable pelvic condition. Supporting documentation should indicate the associated diagnosis, which is typically coded separately.

N94.6 – Dysmenorrhea, unspecified

This option may be used when documentation confirms painful menstruation but does not specify whether the condition is primary or secondary.

Thoughtful selection within dysmenorrhea ICD-10 coding improves diagnostic clarity and ensures the patient’s experience is accurately reflected in the medical record.

Documenting for accurate dysmenorrhea ICD-10 coding

Clear documentation is the foundation of appropriate ICD-10 use. For dysmenorrhea, certain details consistently strengthen coding accuracy and reflect the scope of care provided.

Key elements to document include:

• Timing and pattern of pain in relation to the menstrual cycle

• Associated symptoms such as pelvic pain, lumbar discomfort, or gastrointestinal complaints

• History of gynecologic conditions or prior pelvic procedures

• Impact on daily function, activity tolerance, or work participation

• Relevant clinical findings from pelvic or musculoskeletal assessment

When secondary dysmenorrhea is suspected, documentation should clearly note the suspected or confirmed underlying condition. This allows N94.5 to be paired with the appropriate gynecologic diagnosis code, strengthening both clinical communication and data accuracy.¹

Why does dysmenorrhea ICD-10 matter in women’s healthcare

Although dysmenorrhea is common, it is often underrepresented in clinical records. When menstrual pain is minimized or coded imprecisely, its impact on function and quality of life can be overlooked.

Consistent, accurate use of dysmenorrhea ICD-10 helps:

• Clarify the purpose of visits related to pelvic or menstrual pain

• Support referrals and interdisciplinary coordination when secondary causes are suspected

• Improve consistency in clinical data tied to menstrual health

• Align diagnoses with documented functional limitations and symptom patterns

Over time, precise coding contributes to continuity of care—especially for individuals managing cyclical pelvic pain across multiple encounters.

Clinical example: Applying Dysmenorrhea ICD-10 in practice

Clinical scenario

A 29-year-old patient presents with a history of recurrent lower abdominal cramping and low back pain associated with menstruation. Symptoms typically begin one day prior to menses and continue through the first two days of the menstrual cycle. The patient reports these symptoms have been present since adolescence and occur consistently with each cycle.

The patient denies abnormal uterine bleeding, dyspareunia, or progressive worsening of symptoms. Medical history and prior gynecologic evaluation do not indicate known pelvic pathology. Recent pelvic imaging and clinical examination do not reveal findings suggestive of endometriosis, fibroids, or other secondary causes. Menstrual pain interferes with work attendance and limits physical activity during menses.

Coding approach

N94.4 – Primary dysmenorrhea

This code selection is supported by the cyclical nature of symptoms, long-standing onset beginning in adolescence, absence of identified pelvic pathology, and documented functional impact. Clinical documentation reflects features consistent with primary dysmenorrhea, supporting an appropriate ICD-10 assignment for dysmenorrhea.

If future evaluation identified an underlying condition—such as endometriosis or adenomyosis—N94.5 (secondary dysmenorrhea) would be reported alongside the corresponding gynecologic diagnosis to reflect the updated clinical picture.

Supporting coordinated women’s healthcare

Dysmenorrhea is a common and clinically meaningful concern in women’s health—particularly when symptoms affect function, participation, and quality of life across different life stages. Using dysmenorrhea ICD-10 accurately helps ensure that menstrual pain is clearly documented, appropriately classified, and reflected as more than a routine or expected symptom.

Distinguishing between primary and secondary dysmenorrhea allows clinical records to capture not only the presence of pain, but also whether symptoms may be linked to underlying gynecologic conditions that require further evaluation or coordinated care. That clarity supports stronger clinical communication, more targeted interventions, and better continuity of care across providers and settings.

Delivering this level of consistency takes more than accurate coding alone—it requires care models that extend beyond a single visit. Medbridge supports women’s healthcare delivery through scalable, evidence-based rehabilitation programs designed to expand access, reduce burden, and support pelvic pain and pelvic health concerns across pregnancy, postpartum recovery, and other life stages. By combining engaging digital care at home with proactive progress monitoring, these approaches help providers maintain continuity and support women without expanding their physical footprint.

Aligning women’s health management with coding

Dysmenorrhea is often addressed within a broader women’s health plan of care that includes symptom tracking, patient education, and coordination with other providers. Aligning diagnosis codes with documented findings supports transparency and continuity across the care continuum.

When documentation clearly reflects symptom patterns, suspected contributors, and functional impact, dysmenorrhea ICD-10 coding becomes a direct extension of clinical reasoning rather than an administrative task. Accurate coding helps reinforce menstrual pain as a meaningful clinical concern—one that warrants thoughtful assessment, coordinated management, and ongoing support within women’s healthcare.

Medbridge’s Women’s Health Pathways were designed to complement this clinical decision-making by extending evidence-based care into daily life—helping patients stay engaged, build confidence, and progress toward meaningful recovery.

Pathways offer guided education, pelvic floor and core training, and symptom-specific digital care plans that directly align with the most common contributors captured through dysmenorrhea ICD-10 coding, including:

• pregnancy-related musculoskeletal pain

• postpartum pelvic floor dysfunction

• urinary incontinence

• menopause-related changes

By integrating precise ICD-10 documentation with structured digital pathways, providers can deliver timely, guideline-aligned pelvic health care, reduce delays, expand access, and support women across the lifespan—without increasing clinical burden. Together, these tools help ensure that more women receive the comprehensive, high-quality support they deserve.

Reference

1. American College of Obstetricians and Gynecologists. (2018, December). Dysmenorrhea and endometriosis in the adolescent (Committee Opinion No. 760). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/12/dysmenorrhea-and-endometriosis-in-the-adolescent