Dysmenorrhea is a medical condition defined as the pain and discomfort experienced during menstruation. Menstrual pain is usually experienced in the form of abdominal cramps and comes in two forms: primary and secondary dysmenorrhea. The former is more commonly experienced by women—affecting more than half of the women population—and is not a symptom of any underlying gynecologic condition or structural abnormality. This form often occurs to women in their adolescence. On the other hand, secondary dysmenorrhea is diagnosed to women who experience menstrual pain due to a disorder or disease and usually occurs to adults.
The primary symptom of dysmenorrhea is pain. This occurs in the lower abdominal area, and may also spread to the lower back, hips, and upper thighs. The pain is described to range from spasmodic, sharp, throbbing cramps to congestive dull, radiating aches. For most women, the pain starts before or during the menstrual period and is most severe during the first twenty-four hours, lasting one to two days from the start of the period. This gradually subsides on the succeeding days.
Dysmenorrhea is not considered a medical emergency and there is yet to be a universally accepted standard used to measure the degree of menstrual pain. The more common primary dysmenorrhea is intermittent and usually consists of a dull ache, tolerable to most individuals. However, the secondary form can last two to three days after the menstrual period. Women are advised to seek medical attention when the severity of pain spreads to other areas of the body and interferes with daily activities like walking, commuting, and going to work.
Other symptoms include a lack of energy, nausea, vomiting, diarrhea or constipation, headache, dizziness, urinary infrequency, and disorientation. Dysmenorrhea also affects the mood of an individual in the form of irritability, nervousness, restlessness, and, in more extreme cases, depression. Blood clots or clumps of bloody tissue expelled from the uterus will usually accompany the menstrual cramps as well as menorrhagia, the excessive loss of blood. Some symptoms—such as severely irregular menstruation and late onset of dysmenorrhea, which occurs after a woman reaches twenty-five years old—only manifest in secondary dysmenorrhea.
One probable cause of primary dysmenorrhea is attributed to excessive levels of prostaglandins. At the beginning of the menstrual cycle, the endometrium thickens to prepare for pregnancy. When there is no conception, the built-up uterine tissue is shed through menstruation, and prostaglandins are released due to the destruction of the endometrial cells. These hormones, responsible for pains response, cause the uterus to contract and discomfort occurs in the form of menstrual cramps. The excess in prostaglandins could also lead to a longer duration and increased severity of pain.
Other medical issues that can cause primary dysmenorrhea include a retroverted uterus (a uterus that tilts backward) and instances when the cervical canal is considerably narrow, inhibiting the release of endometrial tissue.
A woman’s lifestyle also contributes to the occurrence of primary dysmenorrhea. Unhealthy conditions and practices such as being overweight, lack of physical exercise, stressful activity, smoking, and alcohol consumption are common factors.
On the other hand, secondary dysmenorrhea can be caused by the following medical conditions: ovarian tumors, infection of the fallopian tubes, endomentriosis, sexually-transmitted infections, fibroids, adenomyosis, hormonal imbalance, imperforated hymen, and vaginal septum. And actions such as the use of intrauterine device and other invasive birth control methods as well as internal scarring can also cause menstrual pain.
Most women use NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen, naproxen, and mefanamic acid to relieve the pain by controlling the production of prostaglandins and reducing contraction in the uterus. These are taken about two days before menses begins and up to two days after the cycle ends. However, these can gave side effects such as nausea, peptic ulcer, dyspepsia, and diarrhea.
The use of oral contraception and hormone medication is also recognized to relieve symptoms of primary dysmenorrhea. With the prescription of a doctor, oral contraceptives may be used to minimize the flow of menstruation, control urine contractions, and inhibit excessive ovulation. Continued medication also offers the additional benefits of regulating menstrual flow and guaranteeing birth control while hormonal treatment may use GnRH agonists, progestins, and danazol for relief.
There are also alternative treatments for the pain of dysmenorrhea. Acupuncture and transcutaneous electrical simulation (TENS) have been acknowledged to relieve pain. Other alternative treatments include vitamin B1, magnesium and iron supplements, herbal concoctions, and acupressure.
Although these treatments have been known to relieve cramps and aid in the relaxation and stress relief of some women, doctors still advise the use of these treatments with caution since they may cause side effects or possibly inhibit the effectiveness of over-the-counter medicines that are already being taken by the patient.
Aside from these, there are also a number of non-medicinal home treatments that can be applied to relieve primary dysmenorrhea. Simple chiropractic treatment involves pacing the spine in a comfortable position, thus relieving symptoms such as lower back pressure, abdominal pain, dizziness, and headaches. Gentle abdominal massages, warm baths, warm baths, hot compresses, and mild exercises like walking and stretching are also done to minimize cramping and relieve pain.
The treatment of secondary dysmenorrhea will depend on the treatment of it underlying cause. Surgery may be performed to remove fibroids, tumors, and ovarian cysts. Patients with severe endometriosis may need a hysterectomy while bacterial infections are easily managed through antibiotics. In certain cases where the treatment is not successful and the pain is severe, more extreme measures may be taken in the form of surgery that is done to sever the uterine nerves by dividing the sacrouterine ligaments or through presacral neurectomy. While this may ease the dysmenorrhea, surgery of this form runs the risk of injuring nearby organs.
The key to preventing dysmenorrhea is adapting a healthy lifestyle. This entails a proper diet consisting of food rich in fiber, nutrients, essential fatty acids, and low-fat protein, as well as avoiding fatty and sugary food and caffeine. Limiting—better yet, avoiding activities such as smoking and drinking alcoholic beverages will also prevent menstrual pain. Overweight women are more likely to suffer from dysmenorrhea, so regular exercise, at least three or four times a week, and stress-relieving activities are also encouraged to reduce tension and relax the body.
Doctors advise women to have regular checkups in order for them to properly assess the specific needs of women based on the patient’s menstrual cycle and individual response to various treatments.