Introduction

Dysmenorrhea is the medical term for very painful menstrual cramps.  All females may experience cramps at one time or another, but for those with dysmenorrhea, severe pain and stomach problems may interfere with their daily activities.  Dysmenorrhea may or may not be caused by an underlying condition, such as endometriosis or fibroids .  There are many treatments to help dysmenorrhea, including self-care measures, medications, or surgery to treat the underlying causes.

Anatomy

The menstrual cycle is a regular process that is regulated by hormones.  The average menstrual cycle lasts around 28 days, but it varies among individuals and may be either longer or shorter.  Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg.  An egg that is fertilized by a sperm cell may implant itself in the nourishing uterine lining and develop into a baby.  An unfertilized egg or a fertilized egg that does not implant in the uterus passes through the reproductive system.  During menstruation, prostaglandins, a hormone-like substance, cause the uterus to contract.  The uterine lining sheds and the blood leaves the body through the vagina.

Causes

Dysmenorrhea is classified as primary or secondary.  Primary dysmenorrhea is not caused by an underlying condition.  It usually begins three to four years after a female has started menstruating.  It is suspected that prostaglandins may contribute to painful cramps by creating greater uterine contractions.  Primary dysmenorrhea usually decreases with age and disappears after childbirth.

An underlying medical condition or disease causes secondary dysmenorrhea.  It usually begins when women are in their twenties.  Secondary dysmenorrhea may be caused by a physical condition, such as uterine fibroids, uterine polyps, ovarian cysts, or endometriosis.  Sexually transmitted diseases, pelvic inflammatory disease, or an intrauterine device (IUD) are other causes.

Symptoms

Dysmenorrhea causes severe painful cramps in the lower abdomen.  It may be a sharp pain that comes and goes or a dull aching pain.  Pain may be felt in the back and legs.  Pain usually begins one or two days before a period begins and lasts for one or two days into the period.  Dysmenorrhea may cause stomach problems, including nausea, vomiting, diarrhea, and constipation.  It may also cause sweating or dizziness.  For some people, severe symptoms prevent participation in daily activities, such as going to work or school.

Diagnosis

To help diagnose dysmenorrhea, your doctor will review your medical history and conduct a physical and pelvic examination.  Determining the cause of secondary dysmenorrhea is important for treatment planning.  Your doctor will check your reproductive organs for any structural abnormalities or signs of infection.  Samples of your vaginal cells may be collected to identify sexually transmitted diseases.

Imaging tests or special procedures may be used to look for abnormal growths or conditions.  Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans may be used to create pictures of your internal pelvic structures.

A laparoscopy is a surgical procedure that allows your doctor to view your pelvic cavity.  It involves inserting a thin tube with a lighting device through a small incision in your abdomen.  A laparoscopy is an outpatient test that uses general anesthesia.  A hysteroscopy uses a viewing instrument that is inserted through your vagina and cervix to examine the inside of the uterus.

Treatment

Treatment for dysmenorrhea may depend on the extent of your symptoms and if you have primary or secondary dysmenorrhea.  In some cases, self-care measures may help relieve your symptoms.  You may want to try placing a heating pad on your abdomen or soaking in a hot bath.  It is important to get plenty of rest and relaxation.  Regular exercise is helpful to release endorphins, your body’s natural painkillers.  It may be helpful to participate in stress-relieving activities, such as massage or yoga.  Vitamins B-6, calcium, and magnesium may help prevent pain associated with PMS.  In 1998 the National Institutes of Health issued a statement that acupuncture may help relieve menstrual pain.
Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) including, aspirin, ibuprofen, or naproxen, may help relieve pain.  Your doctor may prescribe low-dose birth control pills for 6 to 12 months to help reduce the production of prostaglandins associated with dysmenorrhea.
Treatment for the underlying cause of secondary dysmenorrhea depends on the type of condition or disease.  Cysts, polyps, fibroids, and endometriosis may be removed with surgery.  Antibiotics are used to treat sexually transmitted diseases.  An IUD may be removed if it is causing pain.

Prevention

You may be able to prevent secondary dysmenorrhea by avoiding contact with sexually transmitted diseases.  This can be achieved by abstinence.  Female or male condoms may help reduce the spread of some types of sexually transmitted diseases.

Am I at Risk

Risk factors may increase your likelihood of developing dysmenorrhea, although some people that develop the condition do not have any risk factors.  People with all of the risk factors may never develop the dysmenorrhea; however, the chance of developing the condition increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns.

Risk factors for dysmenorrhea:

  • Females with an early onset of puberty (before 11 years old) have an increased risk of developing dysmenorrhea.
  • A family history of dysmenorrhea increases your risk for the condition.
  • Endometriosis is a cause of secondary dysmenorrhea.
  • Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that is caused by sexually transmitted bacteria.  PID can cause secondary dysmenorrhea.
  • Uterine fibroids or polyps can cause secondary dysmenorrhea.
  • Ovarian cysts can cause secondary dysmenorrhea.
  • Premenstrual syndrome (PMS) may contribute to dysmenorrhea.

Complications

Severe dysmenorrhea may cause symptoms that impair a female’s ability to participate in her daily activities.  Severe dysmenorrhea is a leading cause of work or school absence for female.