Table of Contents
What is Dysmenorrhea and Definition
Dysmenorrhea – Cramping, PAIN, abdominal bloating, and other discomforts associated with MENSTRUATION. Primary dysmenorrhea occurs without underlying health conditions that cause such symptoms and generally begins within two or three years of MENARCHE (the onset of menstruation). Secondary dysmenorrhea occurs because of underlying health conditions such as ENDOMETRIOSIS or UTERINE FIBROIDS and typically begins later in a woman’s life as these conditions develop. Congenital anomalies that affect the way menstrual material flows from the body may also cause secondary dysmenorrhea that is present from menarche.
Doctors believe primary dysmenorrhea, which is the more common form of dysmenorrhea, results from the combination of hormonal actions that reduce BLOOD flow to the endometrium (lining of the UTERUS that thickens in the first half of the MENSTRUAL CYCLE to prepare the uterus for possible PREGNANCY) and initiate menstruation. As the body’s balance of estrogen and progesterone shifts, the uterus releases PROSTAGLANDINS and vasopressin. These hormones cause the smooth MUSCLEtissue of the uterus to contract, helping expel the sloughed endometrial tissue that forms the menstrual discharge. Prostaglandins also play a key role in INFLAMMATION and sensitize NERVE endings to pain signals.
Symptoms of Dysmenorrhea and Diagnostic Path
Dysmenorrhea presents a characteristic spectrum of symptoms that occur in varying degrees among different women though are usually consistent from period to period in an individual woman. These symptoms may include
- crampy pain in the lower abdomen, often extending into the lower back and sometimes occurring in a combination of steady cramps with intermittent spasms or outright pain
- sensation of heaviness in the lower abdomen
- bloating (fluid retention)
- NAUSEA and VOMITING
- bowel disturbances (CONSTIPATION or DIARRHEA)
Symptoms often vary in severity over the course of the menstrual period, typically being more severe during the first two to three days of menstrual bleeding. About 10 percent of women who have dysmenorrhea have symptoms severe enough to prevent their participation in regular daily activities. The diagnostic path begins with a medical examination that includes a comprehensive health history (including history of sexual activity), PELVIC EXAMINATION, PAP TEST, and laboratory tests for SEXUALLY TRANSMITTED DISEASES (STDS). Any abnormal findings suggest secondary dysmenorrhea and require additional assessment and appropriate diagnostic procedures. Normal findings establish a presumed diagnosis of primary dysmenorrhea.
Dysmenorrhea Treatment Options and Outlook
Medications are the first choice of treatment for primary dysmenorrhea. Those that provide the greatest level of relief are NONSTEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS), which block the release of prostaglandins, and oral contraceptives (birth control pills), which regulate the estrogen–progesterone balance as well as reduce prostaglandin release. Some women obtain adequate relief from over-the-counter NSAIDs; other women require stronger prescription NSAIDs. For severe dysmenorrhea that does not improve with these treatments, the gynecologist may recommend extended cycle oral contraceptives, a therapy that reduces the frequency of menstrual periods to every three months, or HORMONE THERAPY to suppress menstruation up to 12 months. Lifestyle and complementary methods for relief of symptoms include ACUPUNCTURE, thiamine supplementation, herbal therapies, dietary changes to decrease inflammation, heat to the lower abdomen or back, progesterone cream, and daily physical exercise. Treatment for secondary dysmenorrhea targets the underlying condition as well as symptom relief.
|MEDICATIONS TO TREAT DYSMENORRHEA|
|diclofenac||ethinyl estradiol and norethindrone|
|ethinyl estradiol and norgestimate||ibuprofen|
Risk Factors and Preventive Measures
Menstrual cramps and associated discomforts are very common among menstruating women. Women who have a heavy menstrual flow, who have not carried a pregnancy to term, or who smoke cigarettes are more likely to have dysmenorrhea. Physical inactivity, OBESITY, and chronic PELVIC INFLAMMATORY DISEASE (PID) may also influence dysmenorrhea. Health conditions that may exacerbate dysmenorrhea include DYSFUNCTIONAL UTERINE BLEEDING (DUB), endometriosis, and uterine fibroids. Because dysmenorrhea occurs only among menstruating women, the end of menstruation brings the end of dysmenorrhea. Circumstances that end menstruation include MENOPAUSE (the natural cessation of the menstrual cycle that occurs with aging), HYSTERECTOMY(surgical removal of the uterus), and some treatments for cancer such as CHEMOTHERAPY or RADIATION THERAPY to the abdomen.