Dysmenorrhea

What is dysmenorrhea?

Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.

• Primary dysmenorrhea: From the beginning and usually lifelong; severe and frequent menstrual cramping caused by severe and abnormal uterine contractions.
• Secondary dysmenorrhea: Due to some physical cause and usually of later onset; painful menstrual periods caused by another medical condition present in the body (i.e., pelvic inflammatory disease, endometriosis).

While any woman can develop dysmenorrhea, the following women may be at an increased risk for the condition:

• Women who smoke
• Women who drink alcohol during menses (alcohol tends to prolong menstrual pain)
• Women who are overweight
• Women who started menstruating before the age of 11

What causes dysmenorrhea?

The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, women with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body. Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. Other possible causes of secondary dysmenorrhea include the following:

• Pelvic inflammatory disease (PID)
• Uterine fibroids
• Abnormal pregnancy (i.e., miscarriage, ectopic)
• Infection, tumors, or polyps in the pelvic cavity

What are the symptoms of dysmenorrhea?

Each individual may experience symptoms differently. Symptoms may include:

• Cramping in the lower abdomen
• Pain in the lower abdomen, lower back, or radiating down the legs
• Nausea
• Vomiting
• Diarrhea
• Fatigue
• Weakness
• Fainting
• Headaches

How is dysmenorrhea diagnosed?

Diagnosis begins with an evaluation of the patient's medical history and a complete physical examination, including a pelvic examination. A diagnosis of dysmenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, diagnostic procedures for dysmenorrhea may include the following:

• Ultrasound: A diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
• Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• Laparoscopy: A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.
• Hysteroscopy: A visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.

How is dysmenorrhea treated?

Specific treatment for dysmenorrhea will be determined by your physician based on your age, medical history, and preferences. Possible treatment protocols for managing dysmenorrhea may include:

• Prostaglandin inhibitors, such as nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin and ibuprofen (to reduce pain)
• Acetaminophen
• Oral contraceptives
• Progesterone
• Dietary modifications (to increase protein and decrease sugar and caffeine intake)
• Vitamin supplements
• Regular exercise
• Heating pad across the abdomen
• Hot bath or shower
• Abdominal massage
• Endometrial ablation: A procedure to destroy the lining of the uterus
• Endometrial resection: A procedure to remove the lining of the uterus
• Hysterectomy: Surgical removal of the uterus