Dysmenorrhea

Dysmenorrhea is the term for painful menstruation. It occurs most commonly in teenagers and in women who have never been pregnant.

There are two types of dysmenorrhea. Primary dysmenorrhea is a recurring condition, usually beginning shortly after the onset of menstruation in a young girl. Secondary dysmenorrhea develops later in life, after a woman has been menstruating for some time.

Dysmenorrhea is not a serious condition, but it can be annoying, uncomfortable, and even incapacitating. Since secondary dysmenorrhea usually indicates that another disorder is present, treatment should always be sought for this condition.

Causes

The cause of primary dysmenorrhea is thought to be the release of excess prostaglandins from the lining of the uterus shortly before the beginning of a menstrual period. (Prostaglandins are substances that, among other functions, stimulate uterine contractions.) The resulting contractions constrict blood vessels in the uterus, causing pain in the same way that a decrease in blood supply to the heart causes chest pain. The reason for this excessive production of prostaglandins is not known. Secondary dysmenorrhea is usually a result of another reproductive problem, such as fibroid tumors, a narrow cervix, or endometriosis (the displacement of tissue from the uterine lining to areas elsewhere in the body).

Symptoms

The major symptoms of dysmenorrhea are cramps and pain in the lower abdomen, possibly extending around to the back. Nausea, vomiting, diarrhea, headache, fatigue, and nervousness are mainly associated with primary dysmenorrhea. These symptoms usually appear at the beginning of, or slightly before, the menstrual period, and may last several hours or several days.

Diagnosis

Diagnostic evaluation will include a complete physical examination as well as medical and menstrual histories. If the symptoms have been present from the onset of menstruation at puberty, primary dysmenorrhea is usually the diagnosis. If the symptoms appeared suddenly in a woman who has been menstruating for some years, secondary dysmenorrhea can be assumed. In that case, further diagnostic evaluation of the reproductive organs will then be necessary to identify the underlying disorder. Ultrasound examinations (in which the echoes of sound waves are used to create images of internal structures) or X-ray studies often prove useful.

Treatment

Primary dysmenorrhea has been successfully treated with non-steroidal anti-inflammatory drugs (such as ibuprofen, naproxen, meclofenamate, diflunisal, and mefenamic acid), which, when taken just before a period is to begin, act to suppress the production of prostaglandins and thereby reduce the intensity of the contractions that cause pain.

Secondary dysmenorrhea is treated by correcting the problem that is causing it. For instance, if endometriosis is the underlying problem, it may be treated with hormone therapy or surgery, thereby relieving the dysmenorrhea as well.

Home remedies often help to ease menstrual pain and relieve pressure. These include placing a hot-water bottle or heating pad on the abdomen, taking hot baths, and lying on the back with the knees bent. A woman who experienced dysmenorrhea before pregnancy may find that the problem is lessened after childbirth, possibly because of enlargement of the cervix or destruction of some nerve fibers in the uterus.