Dysmenorrhea is painful menstruation. It may include pain in the abdomen, back and legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their life. In some women, the pain is severe enough to interfere with normal activities.
There are two types of dysmenorrhea:
Primary dysmenorrhea: painful periods without an underlying cause, usually beginning during adolescence
Secondary dysmenorrhea: painful periods due to an underlying condition, such as endometriosis (a condition involving the lining of the uterus or womb) or infection, that can begin at any age.
Causes
Primary dysmenorrhea has no known underlying cause, but appears to be due to high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.
Secondary dysmenorrhea can be caused by:
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Endometriosis
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Ovarian cysts
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Pelvic inflammatory disease (infection of the female reproductive organs)
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Uterine fibroids (noncancerous growths in the uterus)
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Intrauterine contraceptive devices (IUDs)
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Scars inside the abdomen from previous surgery
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Tumors
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Inflammatory bowel disease
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition.
Risk factors for primary dysmenorrhea include:
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Age: less than 20 years old
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Early onset of menstruation (less than 12 years old)
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Depression or anxiety
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Attempts to lose weight (in women 14-20 years old)
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Heavy bleeding during periods
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Nulliparity (never having delivered a baby)
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Smoking
The presence of a known cause of secondary dysmenorrhea (see “Causes”) is a risk factor for developing the condition.
Symptoms
The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing or dull and aching, depending on the individual. It is most typically located in the lower abdomen and may radiate to the low back or thighs. Other symptoms may include:
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Nausea
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Vomiting
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Diarrhea
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Headache
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Irritability
Diagnosis
Your doctor will ask detailed questions about your symptoms and medical history, and perform a pelvic examination.
Diagnostic tests may include:
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Pelvic ultrasound: a test that uses sound waves to examine structures in the pelvis
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Pelvic laparoscopy: a thin, lighted tube inserted through a small incision in the abdomen to view structures in the pelvis
These tests are usually performed to look for causes of secondary dysmenorrhea.
Treatment
The treatment of secondary dysmenorrhea varies depending on the underlying condition (for example, antibiotics for an infection or surgery to remove fibroids).
Primary dysmenorrhea is usually treated with medications and lifestyle changes.
Medications
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Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen, to reduce levels of prostaglandins in the uterus and decrease pain
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Herbal supplements such as evening primrose oil, ginger tea, or valerian
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Oral contraceptives, which prevent ovulation and reduce menstrual blood flow (This is particularly useful in women interested in contraception.)
Lifestyle changes
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Using a heating pad on your abdomen or taking a warm bath can reduce the discomfort of dysmenorrhea
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B vitamins, magnesium, and omega-3 fatty acid supplements may be helpful in some women
Prevention
To help reduce your chance of getting dysmenorrhea, take the following steps:
RESOURCES:
American Academy of Family Physicians
http://www.aafp.org
Mayo Clinic
http://www.mayoclinic.com
CANADIAN RESOURCES:
BC Health Guide
http://www.bchealthguide.org
The Society of Obstetricians and Gynaecologists of Canada (SOGC)
http://www.sogc.org
References:
Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999;60:489-496.
Dysmenorrhea: painful menstrual periods. American Academy of Family Physicians website. Available at: http://www.familydoctor.org/829.xml?printxml. Accessed August 10, 2005.
French L. Dysmenorrhea. Am Fam Physician. 2005;71:285-291.
Menstrual cramps (dysmenorrhea). Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00506. Accessed August 12. 2005.
