Dysmenorrhea
(Painful Menstrual Cycles; Menstrual Cramps)
Pronounced: dis-men-oh-REE-ah
by
Diane W. Shannon, MD, MPH
Definition |
Causes |
Risk Factors |
Symptoms |
Diagnosis |
Treatment |
Prevention
Definition
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 regular (ovulatory) menstrual cycles; the pain is caused by utrine muscle contractions caused by high levels of prostaglandins produced in the lining and body of the uterus after ovulation.
-
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
Menstrual Flow
© 2009 Nucleus Medical Media, Inc.
Causes
Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.
Secondary dysmenorrhea can be caused by:
Risk Factors
Risk factors for primary dysmenorrhea include:
- Ovulatory menstrual cycles ( a normal physiologic condition)
- Age: less than 20
years old
- Early onset of menstruation (less than 12 years old)
- Depression
or
anxiety
- Attempts to lose weight (in women 14-20 years old)
- Heavy bleeding during periods
- Nulliparity (never having delivered a baby)
- 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:
- Nausea
- Vomiting
- Diarrhea
- Headache
- Irritability
Diagnosis
Your doctor will ask detailed questions about your symptoms and medical history, and perform a pelvic examination.
Diagnostic tests may include:
-
Pelvic
ultrasound
-a test that uses sound waves to examine structures in the pelvis
-
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
- Nonsteroidal anti-inflammatory drugs (NSAIDS)
- Oral contraceptives
Other Treatments
- Using a heating pad on your abdomen or taking a warm bath can relieve discomfort.
-
Some herbs and supplements may be helpful, such as
B1,
magnesium, and
Chinese Herbal Medicine.
- Talk to your doctor before taking any herbs and supplements. They may interact with your other medications and conditions.
- Acupuncture
can reduce pain.
If you are diagnosed with dysmenorrhea, follow your doctor's
instructions.
Prevention
To help reduce your chance of dysmenorrhea, take the following steps:
- Exercise regularly.
-
If you smoke,
quit.
- Drink only moderate amounts of caffeine and alcohol.
RESOURCES:
American Academy of Family Physicians
http://www.aafp.org
The American College of Obstetricians and Gynecologists
http://www.acog.org/publications/patient_education/
Women's Health.gov
http://www.4woman.gov/
CANADIAN RESOURCES:
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org
Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm
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.
Speroff L.
Clinical Gynecologic Endocrinology and Infertility.
6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1999.
¹9/30/2008 DynaMed's Systematic Literature Surveillance
http://www.ebscohost.com/dynamed/what.php
: Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care.
Am J Obstet Gynecol.
2008;198:166.e1-8.
Last reviewed November 2009 by Ganson Purcell Jr., MD, FACOG, FACPE
Last Updated: 11/30/2009
