1. Summary
A term for moderate to severe pain caused by menstrual periods
Symptoms include menstrual cramps, achiness in lower abdomen, constipation, diarrhea, headache
Treatment includes non-steroidal anti-inflammatory drugs, lifestyle changes, medications
Involves obstetrics, gynecology & reproductive sciences, pediatric & adolescent gynecology
2. Overview
Most women experience some amount of pain and discomfort associated with their period. Menstrual cramps are the leading cause of absenteeism in women younger than 30.
But there’s actually a medical term that describes the condition when it is uncomfortable enough to warrant treatment: dysmenorrhea.
Its symptoms, which can be constant or sporadic, can occur before or during a menstrual period and last throughout the cycle.
Dysmenorrhea is common. More than half of women experience some degree of discomfort with their periods.
Although over half of people who have menstrual periods feel some discomfort, up to 10-15% of women with dysmenorrhea find the discomfort so disruptive and debilitating that they stay home from school or work to recuperate.
There are two types of dysmenorrhea: primary and secondary.
- primary, which means the pain is from menstruation itself.
- About half of all women with the condition experience primary dysmenorrhea, which usually occurs within the first few years of menstruation. The problems tend to become less common with age; pain and other symptoms may gradually fade over time. Some may notice their symptoms improve after childbirth.
- secondary, which means the condition is caused by a reproductive system disorder that leads to painful menstrual cramps and other symptoms.
- Secondary dysmenorrhea is more common as women age, when they may develop conditions that can cause painful menstruation.
3. What causes dysmenorrhea?
During a menstrual cycle, the uterus produces different levels of chemicals called prostaglandins. The tissue that lines the uterus makes these chemicals. Prostaglandins cause uterine contractions, leading to cramping as the uterine muscles contract and relax.
People who have high levels of prostaglandin may have more intense contractions of their uterus and more pain. Prostaglandins may also be responsible for vomiting, diarrhea, and headaches that accompany painful periods.
Experts believe that high levels of prostaglandins are responsible for primary dysmenorrhea.
The uterus contracts throughout your menstrual cycle—and more strongly during menstruation.
But if the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the oxygen supply to muscle tissue. You feel pain when part of the muscle briefly loses its supply of oxygen.
The level of prostaglandins drops during a menstrual period, causing symptoms to ease.
Secondary dysmenorrhea can be caused by conditions such as:
- Endometriosis : Endometriosis is the most common cause of secondary dysmenorrhea; it’s a condition where tissue from the inside of the uterus implants in the pelvis. This can cause painful periods, painful bowel movements, pain with sex, and sometimes chronic pelvic pain when not menstruating.
- Uterine adenomyosis: A condition in which the lining of the uterus grows into the walls of the uterus
- Fibroids: Small, noncancerous tumors (benign) or clusters of tumors that can grow in the walls of the uterus.
- Uterine abnormalities
- Ovarian cysts
- Pelvic inflammatory disease: Infections in the reproductive organs
- Abnormal pregnancy, such as an ectopic pregnancy (pregnancy in the tubes, outside the uterus)
- IUD (intrauterine device) used for birth control
- Narrow cervix
- Crohn’s disease
- Urinary disorders
Risk factors for menstrual pain
You may be more likely to have menstrual cramps if:
- You had your first period at an early age (younger than 11).
- Your menstrual periods are heavy.
- You are overweight or obese.
- You smoke cigarettes or drink alcohol.
- You have never been pregnant.
4. What are the symptoms associated with dysmenorrhea?
Besides cramps in the lower abdomen, people who experience dysmenorrhea may also have some of these symptoms , ranging from a mild discomfort to serious pain that interferes with your normal activities.
- Throbbing or achiness in the lower abdomen
- Lower back pain
- Pain or achiness that radiates to the legs or thighs
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Headaches
- Irritability
- Weakness
- Fainting spells (in extreme cases)
- Dizziness
- An increased urge to pee
5. How is dysmenorrhea diagnosed?
Some women don’t need to seek a diagnosis or receive treatment for dysmenorrhea. Others seek medical help if their symptoms intensify.
Your doctors can diagnose the condition after learning about your medical history, performing a physical examination, and offering diagnostic tests.
During the medical history portion of the visit, the doctor will ask questions about the menstrual pain and symptoms. Be prepared to talk about these details:
- The timing of the cramps in relation to the start of the period
- Type of pain
- Your age when the cramps first started
- Any recent change in the pain
- Irregular periods
- Vaginal discharge
- Pain with intercourse
- Infertility
- History of pelvic infections
- Age when your first period happened
- Current medications
- What things seem to improve or worsen the pain
During a physical exam, your doctor will perform a pelvic exam to rule out other conditions or find signs of primary or secondary dysmenorrhea.
The following diagnostic tests may also be used to diagnose dysmenorrhea or rule out other conditions:
- Ultrasound of the pelvic region if the doctor discovers any abnormal masses during the pelvic exam or there is a new onset of menstrual pain.
- A pregnancy test if your periods are irregular or you are not using birth control regularly.
- Cultures for sexually transmitted diseases and a blood test if there are concerns about a possible infection.
- Sonohysterography or hysterosalpingography—specialized tests that look inside the uterus with fluid or dye
- A hysteroscopy is another possible procedure. By inserting a hysteroscope (a thin lighted tube) through the vagina, the doctor can see inside the cervix and the inside of the uterus without incisions.
6. How is dysmenorrhea treated?
Treatments are available for both primary and secondary dysmenorrhea, which may help to improve quality of life.
Many people manage their dysmenorrhea pain and discomfort at home. There are different types of treatment.
a. Medications for menstrual pain
- The best way to relieve painful menstrual cramps is to take Non-steroidal anti-inflammatory drugs (NSAIDs), effective at blocking the effects of prostaglandins in the body and thus relieve pain
When dysmenorrhea pain is too intense to be managed with lifestyle changes or over-the-counter medications, the following may be prescribed:
- Oral contraceptives (birth control pills) containing both estrogen and progestin, which help to suppress ovulation and may reduce symptoms
- Other methods of hormonal contraception, such as the patch, ring, or shot, or long-acting reversible methods such as an intrauterine device (IUD) or implant
- Other medications, which may ease symptoms from secondary causes
- Prescription-strength NSAIDs for pain relief alone or in combination with other medications
b. Menstrual pain home treatment
If anti-inflammatory medicine is not an option or if more relief is needed, you can try these things to relieve menstrual cramps:
- Placing a heating pad on the lower abdomen
- Massage to the back and lower abdomen
- Taking a warm or hot shower or bath
- Going for a walk
- Getting enough sleep
c. Menstrual pain surgery
Surgery can treat some causes of menstrual cramps such as fibroids, polyps, ovarian cysts, or endometriosis.
- D&C is used to remove uterine polyps.
- Laparoscopy is used to treat pelvic endometriosis or ovarian cysts.
- Endometrial ablation destroys the lining of the uterus.
- Hysterectomy completely removes the uterus.
- Myomectomy removes only the fibroids and leaves your uterus.
c. Menstrual Pain Prevention
Prevent painful menstrual cramps with these techniques:
- Keep a healthy body weight.
- Don’t smoke or Quit smoking
- Avoiding alcoholic beverages
- Exercise regularly, especially prior to the start of a period
7. What is the outlook for people with dysmenorrhea?
Dysmenorrhea is uncomfortable to experience, but it typically resolves in a short period of time.
Women with primary dysmenorrhea typically have discomfort and other symptoms for a few days every menstrual cycle. The symptoms may be manageable with over-the-counter medications and home remedies.
People with secondary dysmenorrhea may experience relief if the cause of their symptoms—such as endometriosis—is identified and treated.
All dysmenorrhea resolves at menopause when menstrual cycles cease.