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Definition
Dysmenorrhea is the pain or discomfort ("cramps") during or just before a menstrual period.
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Description
Types of Dysmenorrhea
There are two types of dysmenorrhea - primary and secondary dysmenorrhea.
Primary dysmenorrhea is severe, disabling cramps without underlying illness. Symptoms may include backache, leg pain, nausea, vomiting, diarrhea, headache, and dizziness. This kind of dysmenorrhea usually affects young woman within two years of the onset of menstruation and lasts one or two days each month.
Secondary dysmenorrhea is cramps caused by another medical problem(s) such as endometriosis (abnormalities in the lining of the uterus), adenomyosis (nonmalignant growth of the endometrium into the muscular layer of the uterus), pelvic inflammatory disease, uterine fibroids, cervical narrowing, uterine malposition, pelvic tumors or an IUD (intra-uterine device). This condition usually occurs in older women.
Cramps
When the menstrual cycle begins, prostaglandins (chemical substances that are made by cells in the lining of the uterus) are released by the endometrial cells as they are shed from the uterine lining, causing the uterine muscles to contract. If excessive prostaglandin is present, the normal contraction response can become a strong and painful spasm. As it spasms, the blood flow is cut off temporarily, depriving the uterine muscle of oxygen and thus causing a "cramp." The cramps themselves help push out the menstrual discharge.
Excessive prostaglandin release is also responsible for contraction of the smooth muscle in the intestinal tract; hence the diarrhea, nausea and vomiting. Headache and dizziness may also be the result of high prostaglandin levels.
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Causes and Risk Factors
Primary dysmenorrhea may affect up to 75 percent of women at some time, and 5-6 percent may have incapacitating pain. The frequency of cases increases up to age 20 and then decreases with age.
Secondary dysmenorrhea usually begins well after the age of onset of menstruation, sometimes as late as the third or fourth decade of life.
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Symptoms
A medical history and pelvic exam alone may provide enough information for the doctor to determine whether the cramps are caused by primary dysmenorrhea. In primary dysmenorrhea, the pelvic exam is normal between menses. Examination during menses may produce discomfort but no abnormal findings.
In secondary dysmenorrhea, there may be findings on physical exam. Additional tests may include radiologic studies (including ultrasound) and laparoscopy (involves inserting a tiny, flexible lighted tube through a small incision just below the navel to view the internal abdominal and pelvic organs).
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Treatment
For treatment of primary dysmenorrhea, most doctors prescribe antiprostaglandin drugs or NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, ketoprofen, or naproxen. These drugs inhibit synthesis of prostaglandins, lessen the contractions of the uterus and reduce the menstrual flow. These drugs should be started at the onset of bleeding to avoid inadvertent use during early pregnancy and taken for 2-3 days.
Oral contraceptives are another alternative. By stopping ovulation and decreasing prostaglandin levels, they may eliminate cramps.
Treatment of secondary dysmenorrhea depends on the cause. Endometriosis is the most common cause of secondary dysmenorrhea. Depending on the stage of this disease and the woman's age and desire to have children, the treatment methods vary from conservative drug therapy (androgens, progestins, oral contraceptives and gonadotropin-releasing hormone agonists) to surgical procedures.
If the problem is adenomyosis, a hysterectomy may be necessary. Pelvic inflammatory disease may be treated with antibiotics. Uterine fibroids, fibroid tumors and pelvic tumors are often treated surgically. Cervical narrowing can be corrected with surgery as well.
Occasionally, an IUD (intra-uterine device) may be the cause, and if so, the doctor may prescribe antiprostaglandin drugs, and suggest removing the device and using another form of birth control.
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Self Care
For relief of painful menstrual cramps and their associated discomforts, start with a hot bath. The water helps relax the uterus and other tensions that may be contributing to the problem.
Place a heating pad on your abdomen. The flow of heat can provide soothing, temporary pain relief.
Exercise regularly. Aerobic exercise such as walking, swimming, running, bicycling, and aerobic dance may diminish cramping symptoms. For some women, exercise may inhibit prostaglandins or help release endorphins, the brain's natural painkillers.
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Questions to Ask Your Doctor
Do any tests need to be done to diagnose the cause?
What treatment do you recommend?
Will any medication be prescribed? What are the side effects?
Are there any other measures that may relieve the discomfort?
What kind of exercise is the most beneficial?
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