There are said to be five varieties of this affection, which are termed respectively neuralgic, congestive, obstructive, membranous, and ovarian. Neuralgic dysmenorrhoea is caused by general neuralgia, chlorosis, gouty and rheumatic conditions of the system, high living, especially the use of stimulating condiments and excessive quantities of meat, sexual excess, and secret vice. Congestive dysmenorrhoea is caused by plethora, sudden chill, taking cold at the beginning of menstruation, chronic congestion of the uterus, retroflexion, cellulitis, torpidity of the liver, and constipation of the bowels. Obstructive dys menorrhoea arises from obstruction of the canal of the uterus by anteflexion or other causes, as a fibrous tumor, polypus, or swelling of the mucous membrane from uterine catarrh. The variety known as membranous dysmenorrhoea, in which a cast or mold of the cavity of the uterus is sometimes expelled, is due to chronic congestion of the uterus, ' which is increased at the menstrual periods almost to a condition of inflammation. Ovarian dysmenorrhoea results from congestion and inflammation of the ovaries.

In neuralgic dysmenorrhoea, the patient has throbbing pain in the loins and lower part of the bowels, together with neuralgic pains in other parts of the body. In congestive dysmenorrhoea, when produced by taking cold, as by getting the feet wet just before the time of the menstrual period, the patient suffers with severe pain, often accompanied by a chill, which is followed by fever. When inflammation is present, the pain is dull and heavy. Severe bearing-down pains for a few hours or a day or two before the beginning of the flow, with relief either entirely or to a great extent as soon as the flow is established, indicates obstruction. In membranous dysmenorrhoea, the patient suffers with severe bearing-down pains, which cease as soon as the membrane is expelled. Ovarian dysmenorrhoea is characterized by pain continuing for several days before the period, in one or both groins, and extending down the thighs; there is also, usually, tenderness in one or both breasts. The tenderness in the groin is more or less marked between the menstrual periods.