DYSMENORRHEA

Definition:
Dysmenorrhea is the occurrence of painful cramps during menstruation.

Description:
More than half of all girls and women suffer from dysmenorrhea (cramps), a dull or throbbing pain that usually centers in the
lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps.
While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with
everyday activities for several days each month.

Causes

and

symptoms:

Dysmenorrhea is called "primary" when there is no specific abnormality and secondary when the pain is caused by an
underlying gynecological problem. It is believed that primary dysmenorrhea occurs when hormone-like substances called
"prostaglandins" produced by uterine tissue trigger strong muscle contractions in the uterus during menstruation. However, the
level of prostaglandins does not seem to have anything to do with how strong a woman's cramps are. Some women have high
levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts

assume that cramps must also be related to other things (such as genetics, stress, and different body types) in addition to
prostaglandins. The first year or two of a girl's periods are not usually very painful. However, once ovulation begins, the blood
levels of the prostaglandins rise, leading to stronger contractions.
Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the pelvis.
The likelihood that a woman will have cramps increases if she:

has a family history of painful periods

leads a stressful life
does not get enough exercise
uses caffeine
has pelvic inflammatory disease

Symptoms include a dull, throbbing cramping in the lower abdomen that may radiate to the lower back and thighs. In addition,
some women may experience nausea and vomiting, diarrhea, irritability, sweating, or dizziness. Cramps usually last for two or
three days at the beginning of each menstrual period. Many women often notice their painful periods disappear after they have
their first child, probably due to the stretching of the opening of the uterus or because the birth improves the uterine blood
supply and muscle activity.

Types:
1. Primary dysmenorrhea: is menstrual pain that results from factors intrinsic to the uterus and the process of
menstruation. It is extremely common, occurring at least occasionally in almost all women. If the painful episode is mild
and brief, it is considered functional and normal and requires no treatment. In approximately 10% of women,
dysmenorrhea is

sufficiently severe to cause episodes of

partial

disability. The cause in most cases is poorly

or

total

understood;

various

psychosomatic

abnormalities have been suggested. Pain

occurs

in the lower abdomen or back and is

typically

anatomic,

neurohormonal,

and

crampy,

occurring in successive waves, apparently

in

conjunction

with intense uterine contractions and slight

cervical dilation.

Pain usually begins just before or at the

onset

of,

menstrual flow and lasts from a few hours

to 1 day or more.

It may persist through the entire period in a

few women. Pain

is

frequently

associated

with

nausea,

vomiting, and frequent bowel movements with intestinal cramping. Dizziness, fainting, pallor, and obvious distress may
also be observed.

2. Secondary dysmenorrhea: is menstrual pain that occurs secondary to specific pelvic abnormalities, such as
endometriosis, adenomyosis, chronic pelvic infection, chronic pelvic congestion, or degenerating fibroid tumors.
Typically the pain begins earlier in the cycle and lasts longer than the pain of primary dysmenorrhea. Painful bowel or
bladder function may accompany the condition, depending on the location of the specific lesions.

Diagnosis:
A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause
cramps.
The doctor will examine you and ask questions about your medical history and symptoms, such as:

At what age did your periods started?

Have they always been painful? If not, when did the pain start?
At what point in the menstrual cycle experiences pain?

Is the pain sharp, dull, intermittent, constant or colicky?

Is sexually active?
Do you use birth control? What kind?
When was your last period?
Does the amount of your last menstrual period was normal for you?
Do your periods tend to be heavy or prolonged (lasting longer than 5 days)?
Have there been blood clots?
Are your periods generally regular and predictable?
Do you use tampons during menstruation?
What have you done to try to relieve the discomfort? How effective was it?
Does anything make the pain worse?
Do you have other symptoms?

The tests and procedures that may be done include:

Complete blood count (CBC )

Crops to rule STIs
Laparoscopy
Ultrasound

Treatment:
Secondary dysmenorrhea is controlled by treating the underlying disorder. Several drugs can lessen or completely eliminate the
pain of primary dysmenorrhea. The most popular choice are the non-steroidal anti-inflammatory drugs (NSAIDs), which prevent
or decrease the formation of prostaglandins. These include aspirin, ibuprofen (Advil), and naproxen (Aleve). For more severe
pain, prescription strength ibuprofen (Motrin) is available. These drugs are usually begun at the first sign of the period and
taken for a day or two. There are many different types of NSAIDs, and women may find that one works better for them than the
others.
If an NSAID is not available, acetaminophen (Tylenol) may also help ease the pain. Heat applied to the painful area may bring
relief, and a warm bath twice a day also may help. While birth control pills will ease the pain of dysmenorrhea because they
lead to lower hormone levels, they are not usually prescribed just for pain management unless the woman also wants to use
them as a birth control method. This is because these pills may carry other more significant side effects and risks.
New studies of a drug patch containing glyceryl trinitrate to treat dysmenorrhea suggest that it also may help ease pain. This
drug has been used in the past to ease preterm contractions in pregnant women.
Primary dysmenorrhea is a normal cramping of the lower abdomen caused by hormone-induced uterine contractions before the
period. Secondary dysmenorrhea may be caused by abnormal conditions such as endometriosis or pelvic inflammatory
disease. Unless one of these potentially serious conditions is present, the treatment for painful periods is pain relief. If a
hormone imbalance is detected, birth control pills may restore the proper hormone levels.

Alternative treatment:
Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with
knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are
popular ways to ease menstrual pain. In the "cat stretch," position, the woman rests on her hands and knees, slowly arching the
back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and
buttocks.
Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat,
dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Recent research suggests that
vitamin B supplements, primarily vitamin B6 in a complex, magnesium, and fish oil supplements (omega-3 fatty acids) also may
help relieve cramps.
Other women find relief through visualization, concentrating on the pain as a particular color and gaining control of the
sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over
the painful area can actually lessen the pain for brief periods. Exercise may be a way to reduce the pain of menstrual cramps
through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable
by releasing tension in the pelvic muscles. Acupuncture and Chinese herbs are another popular alternative treatments for
cramps.

Prognosis:
Medication should lessen or eliminate pain.

Prevention:
NSAIDs
should

taken a day before the period begins

eliminate cramps for some women.