Dysmenorrhea

General Illness Information


Medical Term:

Dysmenorrhea

Common Name: Menstrual Cramps

Description: Dysmenorrhea is severe painful abdominal cramps at the onset of and during menstruation. Severity of symptoms varies greatly from women to women and from time to time. It is usually less severe after childbirth.

There are two types – Primary and Secondary dysmenorrhea. The condition is called Primary dysmenorrhea when there is no underlying cause and usually occurs in women in their late teens and early twenties. Secondary dysmenorrhea is menstrual pain for which a gynecologic cause exists and it presents much later.

Primary dysmenorrhea is common, affecting approximately 50% of women: it is severe in 5 to 15% . It can be severe enough to interfere with everyday activities, resulting in absence from school or work. Primary dysmenorrhea may become less severe with age and after pregnancy.

Secondary dysmenorrhea is less common, affecting about 25% of women who have dysmenorrhea.

Causes: Primary dysmenorrhea is a symptom, not an illness. The pain of primary dysmenorrhea is the result of strong uterine contractions, probably caused by excess production of prostaglandins. The factors that may worsen the pain includes – a uterus that tilts backwards (retroverted uterus), lack of exercise, and psychological or social stress.

In Secondary dysmenorrhea, underlying causes may include:

  • Endometriosis;
  • Pelvic infection;
  • Uterine tumors – fibroids and adenomyosis (Non cancerous invasion of the muscular wall of the uterus by the uterine lining);
  • Hormonal imbalance;
  • Developmental abnormalities such as imperforate hymen, vaginal septum etc.

Prevention: Dysmenorrhea may be prevented by treatment of the underlying cause.

Signs & Symptoms

  • Cramping and sometimes sharp pains in the lower abdomen, lower back and thighs;
  • Lack of energy;
  • Nausea and vomiting (sometimes);
  • Diarrhea (occasionally);
  • Sweating;
  • Urinary frequency;
  • Irritability, nervousness, depression;
  • Passage of clots and bloody tissue from the lining of the uterus which causes pain.

Risk Factors

  • Family history of dysmenorrhea;
  • Stress. The degree of dysmenorrhea may vary according to general health or mental state. While emotional or psychological factors don’t cause the pain, they can worsen pain or cause some women to be less responsive to treatment;
  • Lack of exercise;
  • Use of caffeine;
  • Pelvic inflammatory disease.

Diagnosis & Treatment

  • Pelvic exam and a patient history and relevant investigations may help suggest the cause of dysmenorrhea;
  • In primary dysmenorrhea, pelvic exam is normal between the menses. In secondary dysmenorrhea, the history and physical examination commonly suggest endometriosis or pelvic inflammatory disease;
  • Diagnostic tests, such as laproscopy is very helpful in differentiating endometriosis from pelvic inflammatory disease.

General Measures:

  • Initial treatment aims are to relieve pain. Long term goals of treatment involve treating any underlying cause with medication, counseling or possibly surgery;
  • Heat helps relieve pain. Use a heating pad or hot-water bottle on the abdomen or back, or take hot baths. Sit in a tub of hot water for 10-15 minutes as often as necessary;
  • Transcutaneous electrical nerve stimulator (TENS) treatment may help relieve pain;
  • Hypnosis therapy may help;
  • Adequate rest and sleep and exercise may be beneficial;
  • Treatment for the cause for secondary dysmenorrhea;
  • For extreme and very severe cases, surgical excision of the uterine nerves may be considered.

Medications:

  • For minor discomfort, you may use non-prescription drugs such as acetaminophen or ibuprofen;
  • Other medications that may be prescribed: most effective are nonsteroidal anti-inflammatories such as naproxen and mefenamic acid;
  • Oral contraceptives, which prohibit ovulation.

Activity:

No restriction. When resting in bed, elevate your feet or bend your knees and lie on your side. Regular, vigorous exercise reduces discomfort of future periods.

Diet:

  • No special diet. You may be prescribed vitamin-B supplements. These help relieve symptoms in some persons;
  • Some herbal tea can reduce symptoms of dysmenorrhea.

Possible Complications :

Severe pain that regularly interferes with normal activity.

Prognosis

Symptoms can be controlled with treatment.

Other

Nothing specified.

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