dysmenorrhea

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Dysmenorrhea

 

Definition

Dysmenorrhea is the occurrance of painful cramps during menstruation.

Description

More than half of all girls and women suffer from dysmenorrhea (cramps), a dull or throbbing pain that usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps.
While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month.

Causes and symptoms

Dysmenorrhea is called "primary" when there is no specific abnormality, and "secondary" when the pain is caused by an underlying gynecological problem. It is believed that primary dysmenorrhea occurs when hormone-like substances called "prostaglandins" produced by uterine tissue trigger strong muscle contractions in the uterus during menstruation. However, the level of prostaglandins does not seem to have anything to do with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts assume that cramps must also be related to other things (such as genetics, stress, and different body types) in addition to prostaglandins. The first year or two of a girl's periods are not usually very painful. However, once ovulation begins, the blood levels of the prostaglandins rise, leading to stronger contractions.
Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the pelvis.
The likelihood that a woman will have cramps increases if she:
  • has a family history of painful periods
  • leads a stressful life
  • does not get enough exercise
  • uses caffeine
  • has pelvic inflammatory disease
Symptoms include a dull, throbbing cramping in the lower abdomen that may radiate to the lower back and thighs. In addition, some women may experience nausea and vomiting, diarrhea, irritability, sweating, or dizziness. Cramps usually last for two or three days at the beginning of each menstrual period. Many women often notice their painful periods disappear after they have their first child, probably due to the stretching of the opening of the uterus or because the birth improves the uterine blood supply and muscle activity.

Diagnosis

A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps.

Treatment

Secondary dysmenorrhea is controlled by treating the underlying disorder.
Several drugs can lessen or completely eliminate the pain of primary dysmenorrhea. The most popular choice are the nonsteroidal anti-inflammatory drugs (NSAIDs), which prevent or decrease the formation of prostaglandins. These include aspirin, ibuprofen (Advil), and naproxen (Aleve). For more severe pain, prescription strength ibuprofen (Motrin) is available. These drugs are usually begun at the first sign of the period and taken for a day or two. There are many different types of NSAIDs, and women may find that one works better for them than the others.
If an NSAID is not available, acetaminophen (Tylenol) may also help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help. While birth control pills will ease the pain of dysmenorrhea because they lead to lower hormone levels, they are not usually prescribed just for pain management unless the woman also wants to use them as a birth control method. This is because these pills may carry other more significant side effects and risks.
New studies of a drug patch containing glyceryl trinitrate to treat dysmenorrhea suggest that it also may help ease pain. This drug has been used in the past to ease preterm contractions in pregnant women.

Alternative treatment

Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are popular ways to ease menstrual pain. In the "cat stretch," position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and buttocks.
Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Recent research suggests that vitamin B supplements, primarily vitamin B6 in a complex, magnesium, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.
Other women find relief through visualization, concentrating on the pain as a particular color and gaining control of the sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods.
Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.
Acupuncture and Chinese herbs are another popular alternative treatments for cramps.

Prognosis

Medication should lessen or eliminate pain.

Prevention

NSAIDs taken a day before the period begins should eliminate cramps for some women.

Resources

Periodicals

McDonald, Claire, and Susan McDonald. "A Woman's Guide to Self-care." Natural Health January-February 1998:121-142.

Organizations

National Women's Health Network. 514 10th St. NW, Suite 400, Washington, DC 20004. (202) 628-7814. http://www.womenshealthnetwork.org.

Key terms

Endometriosis — The growth of uterine tissue outside the uterus.
Hormone — A chemical messenger secreted by a gland and released into the blood, which allows it to travel to distant cells where it exerts an effect.
Ovary — One of the two almond-shaped glands in the female body that produces the hormones estrogen and progesterone.
Ovulation — The monthly release of an egg from an ovary.
Progesterone — The hormone produced by the ovary after ovulation that prepares the uterine lining for a fertilized egg.
Uterus — The female reproductive organ that contains and nourishes a fetus from implantation until birth.

dysmenorrhea

 [dis″men-ŏ-re´ah]
painful menstruation with cramps in the lower abdomen. adj., adj dysmenorrhe´al.Primary dysmenorrhea is painful menstruation with no detectable organic disease. Secondary dysmenorrhea is painful menstruation due to some pelvic pathology, such as endometriosis, pelvic inflammatory disease, or prolapse of the uterus. Relief can often be obtained by simple hygienic measures such as adequate rest, avoidance of constipation, moderate exercise, applications of moderate heat to the abdomen, and removal of restricting clothing. See also premenstrual syndrome.
Treatment. Severe primary dysmenorrhea requires more aggressive therapy. Drugs that may be helpful include ibuprofen (Motrin and Rufen), mefenamic acid (Ponstel), and naproxen sodium (Anaprox). Use of these drugs is not recommended for nursing mothers or in pregnancy. They also often have side effects related to irritation of the gastrointestinal tract. Taking the drug with meals or a glass of milk can mitigate the irritation.

If the patient is not trying to conceive, preventive therapy, rather than symptomatic relief with analgesics, is the preferred mode of treatment. Because prostaglandins are known to produce increased uterine contractions and the cramping typical of dysmenorrhea, inhibition of ovulation can decrease endometrial production of prostaglandins and the concurrent increase in uterine activity. Therefore, oral contraceptives often prove to be effective. Similarly, prostaglandin synthetase inhibitors can provide relief in about 90 per cent of the cases if administration of medication is supplemented with patient education and reassurance. Therapy with these drugs can begin with the onset of bleeding, thus avoiding inadvertent intake of prostaglandin synthetase inhibitors in early pregnancy.
congestive dysmenorrhea that accompanied by great congestion of the uterus.
essential dysmenorrhea painful menstruation for which there is no demonstrable cause.
inflammatory dysmenorrhea that due to inflammation.
obstructive dysmenorrhea that due to mechanical obstruction to the discharge of menstrual fluid.

dys·men·or·rhe·a

(dis'men-ō-rē'ă),
Difficult and painful menstruation.
Synonym(s): menorrhalgia
[dys- + G. mēn, month, + rhoia, a flow]

dysmenorrhea

(dĭs-mĕn′ə-rē′ə)
n.
Painful menstruation.

dys·men′or·rhe′al (-rē′əl), dys·men′or·rhe′ic (-rē′ĭk) adj.

dysmenorrhea

Medtalk Menstrual pain, painful periods. See Dysfunctional uterine bleeding.

dys·men·or·rhe·a

(dis-men'ōr-ē'ă)
Difficult and painful menstruation.
Synonym(s): menorrhalgia, dysmenorrhoea.
[dys- + G. mēn, month, + rhoia, a flow]

Robinson,

E.M.,
Robinson syndrome - dysmenorrhea that begins shortly after menarche. Synonym(s): dysmenorrhea; unilateral genital atresia

dys·men·or·rhe·a

(dis-men'ōr-ē'ă)
Difficult and painful menstruation.
Synonym(s): menorrhalgia, dysmenorrhoea.
[dys- + G. mēn, month, + rhoia, a flow]
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