Dysmenorrhea
Basic Information
Dysmenorrhea is uterine cramping that usually begins with ovulatory menstrual periods.
Primary dysmenorrhea, or functional dysmenorrhea, is very common -- experienced by most women. In fact it has been estimated to be the most common medical problem experienced by women under the age of twenty-five and the major cause of time lost at work or at school for women in this same age group.
Secondary dysmenorrhea is acquired by some demonstrable organic pathology and is much rarer.
Primary dysmenorrhea is thought to result from a high level of prostaglandin production in some women. (This is a substance that the uterus produces.) It occurs only during ovulatory cycles. In women with secondary dysmenorrhea the cause is thought to be endometriosis, adenomyosis, or occasionally IUD use or outflow tract obstruction.
Most women sense when their period is coming b y the telltale signs of feeling blue or mildly anxious or breast tenderness and mild abdominal extension. After bleeding commences, cramps usually centered in the lower abdomen begin within a few hours and recur over the next twelve to forty-eight hours. The cramps usually begin as a dull discomfort, build up within a minute, tend to last up to five minutes and then slowly disappear. These menstrual cramps may be accompanied by other symptoms and they run the range from being quite mild to moderate to severe. When severe enough, the menstrual pain can cause a significant disruption in a woman's daily routine, or in the worst cases, totally incapacitate her. Severe dysmenorrhea is experienced by ten to fifteen percent of women in the U.S.
Sometimes the symptoms of primary dysmenorrhea disappear or resolve on their own and can vary in intensity from period to period. Sometimes the pain or discomfort decreases with advancing age and in some women symptoms decrease after childbirth while in others they do not.
Symptoms OF PRIMARY DYSMENORRHEA
Cramps, most often sharp and colicky (but sometimes a dull, constant ache) begin within hours of the menstrual flow and resolve within twelve to forty-eight hours, usually diminishing quickly. Other symptoms may include:
- low abdominal pain may radiate to the lower back or legs but will be secondary in discomfort to the abdominal pain itself
- nausea
- diarrhea
- constipation
- headache
- urinary frequency
Less common symptoms include:
- sweating
- shaking
- vomiting
- hot flushes (or flashes)
- cardiac palpitations
Premenstrual symptoms of anxiety, depression, irritability and abdominal bloating may be present as well. (See article on PMS.)
Diagnosis/Treatment
Primary dysmenorrhea can be diagnosed by your health care provider in a primary care setting by taking a medical history, exploring the symptoms listed above, and by administering a physical exam to rule out identifiable causes of pelvic pain. Laboratory tests are generally not needed nor utilized for diagnosis.
Once diagnosis is made, your health care provider will treat both physical and psychological symptoms. Remember that primary dysmenorrhea is a symptom complex -- it is not a disease that progresses. Treatment involves not only relieving symptoms but restoring normal functioning should there be a disruption in daily routine.
This is a treatable condition and the patient should be made aware of this from the start to relieve anxiety. Emotional support as well as education can be keys to help alleviate symptoms.
Ibuprofen, an over-the-counter medication, is very effective in relieving symptoms. In most cases taking a 200-milligram tablet every four hours will relieve cramping. The dose may need to be increased to three tablets (600 milligrams) every six hours or even four tablets (800 milligrams) every eight hours. You should discuss the dosage with your health care provider and/or gynecologist to be certain that it is the right amount for you. Many women may already have stomach irritation and taking too much ibuprofen may cause a stomach ulcer.
Never take ibuprofen on an empty stomach or take a higher dosage than your health care provider recommends. Naturally you should not take ibuprofen if:
- you are allergic to it
- have a history of gastritis or ulcer
Other medications may be prescribed for you if you cannot tolerate ibuprofen or if it doesn't work effectively for you. Sometimes your health care provider will prescribe birth control pills that have proven beneficial in reducing cramping.
Sometimes your health care provider will suggest you begin medication before your cramps begin. This is often referred to as "preloading", the goal being to stop inflammation before you go into contractions or enter a "trauma zone".
Heat applied to the lower abdomen can relieve symptoms. Use of a heating pad, hot water bottle, or soaking in a hot tub is often recommended.
Treatment for secondary dysmenorrhea varies from woman to woman, depending on her specific underlying condition. This is a rarer condition in which cramping is caused by a demonstrable pathology. Secondary dysmenorrhea is usually duller in character, starts earlier and lasts longer, increases with age and does not usually present the visceral symptoms associated with primary dysmenorrhea listed above. Physical examination may reveal uterine irregularity, a cul-de-sac tenderness, or nodularity or pelvic masses. If you are diagnosed with secondary dysmenorrhea it is important that you follow through with your health care provider and/or gynecologist for appropriate specialist referral for specific medical or surgical treatment.
If you have dysmenorrhea or would like information about it, please see your health care provider.