Dysmenorrhea can be literally translated as "difficult monthly flow." Although it's normal for most women to have mild abdominal cramps on the first day or two of their period, about 10% of women experience severe pain.
There are two types of dysmenorrhea:
Primary dysmenorrhea is thought to be caused by excessive levels of prostaglandins, hormones that make your uterus contract during menstruation and childbirth. Its pain probably results from contractions of your uterus that occur when the blood supply to its lining (endometrium) is reduced.Other factors that may make the pain of primary dysmenorrhea even worse include a uterus that tilts backward (retroverted uterus) instead of forward, lack of exercise, psychological or social stress, smoking, drinking alcohol, being overweight, and starting menstruating before age 11.
Secondary dysmenorrhea may be caused by a number of conditions, including:
Symptoms and Complications
The main symptom of dysmenorrhea is pain. It occurs in your lower abdomen during menstruation and may also be felt in your hips, lower back, or thighs. Other symptoms may include nausea, vomiting, diarrhea, lightheadedness, or general achiness.For most women, the pain usually starts shortly before or during their menstrual period, peaks after 24 hours, and subsides after 2 to 3 days. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain. Dysmenorrhea pain may be spasmodic (sharp pelvic cramps at the start of menstrual flow) or congestive (deep, dull ache). The symptoms of secondary dysmenorrhea often start sooner in the menstrual cycle than those of primary dysmenorrhea, and usually last longer.
Making the Diagnosis
If you experience painful periods, check with your doctor to see whether you might have an underlying disorder that is causing secondary dysmenorrhea. You may be given a pelvic examination, and your blood and urine may be tested.A doctor may also wish to use ultrasound to get a picture of your internal organs or even use the technique of laparoscopy for a direct look into your uterus.
Treatment and Prevention
Your doctor may prescribe medications or other remedies depending on the cause of the dysmenorrhea.Primary dysmenorrhea is usually treated by medication such as an analgesic medication. Many women find relief with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen*, naproxen, and acetylsalicylic acid (ASA). Some doctors may prescribe hormone medications. Oral contraceptives also may also help reduce the severity of the symptoms. Nausea and vomiting may be relieved with an antinausea (antiemetic) medication, but these symptoms usually disappear without treatment as cramps subside. Implantable contraception and the Mirena IUD, which release low levels of the hormone progesterone, have also been found to be very helpful in decreasing pain. Women who do not respond after three months of treatment with NSAIDs and hormonal contraceptives may have secondary dysmenorrhea. Treatment for secondary dysmenorrhea will vary with the underlying cause. Diagnostic laparoscopy, other hormonal treatments, or trial of transcutaneous electrical nerve stimulation (TENS) are potential next steps. Surgery can be done to remove fibroids or to widen the cervical canal if it is too narrow.
In addition to the above, other non-medicinal treatments for the pain of dysmenorrhea include:
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