DYSMENORRHEA

(Menstrual Cramps)

 Basic information

description

Dysmenorrhea is pain that occurs with menstruation. In primary dysmenorrhea, there is no underlying pelvic condition. It is very common and typically occurs in women under age 20. Secondary dysmenorrhea is associated with pelvic conditions and occurs more often in women over age 20.

FREQUENT SIGNS & SYMPTOMS

• Severity of symptoms varies from woman to woman, and from one time to the next in the same woman.
• Cramping and, sometimes, sharp pains in the lower abdomen, lower back, and thighs. Pain usually begins with a menstrual period and lasts for hours to days. For some women, the pain may begin a week or more before her period and last for a few days after it stops.
• Other symptoms that may occur:
  • Nausea, vomiting, diarrhea, headache, and sweating.
  • Lack of energy.
  • Fainting.
  • Feeling irritable, anxious, or depressed.

causes

• In primary dysmenorrhea, excess prostaglandin (a hormone-like substance) appears to be the cause. It stimulates uterine contractions.
• In secondary dysmenorrhea, the underlying pelvic disorder or abnormality appears to cause the pain.

risk increases with

• Primary dysmenorrhea: family history of dysmenorrhea, age under 20, early menstruation, never being pregnant, obesity, smoking, and alcohol use (possibly). Behavior or psychological factors may also be involved. Some factors may lead to more severe symptoms in those with dysmenorrhea.
• Secondary dysmenorrhea: endometriosis, pelvic inflammatory disease, ovarian cysts or tumors, fibroids, uterine polyps, adenomyosis, congenital (being born with) uterine or vaginal abnormalities, intrauterine device (IUD), or other pelvic disorders.

PREVENTIVE MEASURES

Treatment of the underlying cause.

expected outcomes

• For primary dysmenorrhea, symptoms can be helped with treatment. Symptoms improve or disappear with age and with childbirth.
• For secondary dysmenorrhea, the outcome depends on the cause and successful treatment of that condition.

possible complications

• Severe pain that interferes with normal activity.
• Infertility from underlying cause.

 diagnosis & treatment

general measures

• Your health care provider will do a physical exam and a pelvic exam. Questions will be asked about your menstrual history. Medical tests may include blood and urine studies, and an ultrasound.
• Treatment usually involves drugs to relieve pain.
• For secondary dysmenorrhea, treatment will depend on the cause. Drugs or surgery (such as for removing fibroids) may be recommended.
• Heat helps relieve pain. Use a heating pad or hot-water bottle on the abdomen or back. Take warm baths. Sit in a tub of hot water for 10 to 15 minutes as often as needed.
• Transcutaneous electrical nerve stimulator (TENS) treatment may help relieve pain in some cases.
• Massage therapy, yoga, acupuncture, meditation, or other therapies may help in some cases.
• Counseling may be helpful if emotional problems such as stress are a concern.

medications

• Use nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin (if over age 18) starting 1 to 2 days before period begins.
• Antiprostaglandins (for painful menstrual periods) and oral contraceptives, which prohibit ovulation, may be prescribed.
• In severe cases, hormones (e.g., gonadotropin-releasing hormone [Gn-RH]) can stop ovary function to relieve pain.
• Diet supplements may be recommended. Vitamin E, omega-3 fatty acids, zinc, magnesium, and thiamine may help relieve symptoms in some persons.

activity

Exercise reduces the discomfort of menstrual cramps.

diet

Eat a normal, health diet.

 notify our office if

• You or a family member has symptoms of dysmenorrhea that cannot be relieved.
• Pain worsens or bleeding becomes excessive.

Special Notes: