Dysmenorrhea is a common medical problem occurring in 60 to 93 percent of menstruating females. It is considered primary dysmenorrhea if there are no other problems in the reproductive tract.
This is common in adolescents. Secondary dysmenorrhea occurs if there are related pathologies like endometriosis. It is more common among older women especially in the fourth and fifth decades but may occur in adolescents.
Crampy pain usually occurs in the lower abdominal area but it can present as severe pain in the back or thighs. Pain starts just before a menstrual period or when bleeding begins, decreasing in intensity in one to three days. Dysmenorrhea may be associated with headache, dizziness, nausea or the urge to vomit, diarrhea, tiredness, and body malaise.
Dysmenorrhea is associated with the release of inflammatory chemicals called prostaglandins. These are released by the cells of the so-called endometrial lining of a woman’s uterus as it breaks down just before or during a menstrual period. Prostaglandins cause muscle contractions in the uterus and decrease blood flow and oxygen supply. Pain, discomfort, and the other symptoms ensue.
Complete medical examination that includes abdominal and pelvic examination by a trained health care provider is advised for women or adolescents with painful menstruation. This is to rule out the presence of underlying pathologies like endometriosis, adenomyosis, or fibroids. Conditions that modify decisions on drug therapy also have to be identified. These include acid-related disorders, kidney function impairment, hypertension, and other illnesses in which the use of non-steroidal anti-inflammatory drugs (NSAIDs) has to be carefully evaluated.
Laboratory tests include blood chemistry, urinalysis, and blood count. Ultrasound aids in the diagnosis. Diagnostic laparoscopy is advised in severe cases if endometriosis is being considered as a cause of dysmenorrhea.
Endometriosis is a condition in which the tissue that normally lines the uterus is found in other organs like the fallopian tubes, ovaries, and lining of the pelvic area itself. Laparoscopy is a minimally invasive surgical procedure done under general anesthesia in an operating room. A thin instrument – a telescope with a camera – is inserted through a small incision to see if there is endometrial tissue in other organs.
Diagnostic procedures and treatment take into consideration the woman’s age, symptoms, and coexisting medical problems. Initial treatment includes the use of NSAIDS. These drugs work best when taken as soon as menstrual bleeding or symptoms start. They should then be taken for two to three days on a regular schedule. First or second generation NSAIDs work in the same way and are effective as long as the correct dose is taken at the prescribed intervals. They have to be taken under a health care provider’s supervision because as they reduce prostaglandins that cause dysmenorrhea, they also reduce the amount of these chemicals in organs like the kidneys. Prostaglandin promotes dilatation of blood vessels in the kidneys and participates in blood flow and oxygenation in these organs. Improper use of these drugs can thus cause kidney damage and in the stomach where NSAIDs cause gastric irritation.
NSAIDs may be prescribed simultaneously with birth control tablets and other forms of hormonal therapy if initial treatment with NSAIDs alone does not relieve the symptoms in two to three months. These hormonal treatments thin out the endometrial ling of the uterus and decrease the amount of prostaglandins released.
Heat (temperature of 40 degrees Celsius or 104 Fahrenheit) applied with hot water bottle, self-heating patch, or heating pad to the lower abdomen can reduce pain.
Regular exercise has been shown to reduce pain. Yoga and acupuncture may also provide benefit but additional studies need to be done to see if they are safe and efficacious.
For women who do not like to take medications or where the use of NSAIDs or hormonal therapy is contraindicated, transcutaneous electrical nerve stimulation may reduce pain. This is not however as effective as medications.
If dysmenorrhea does not improve with ordinary measures and medications, patients are advised to seek consult with gynecologists – physicians who are specialists in the work-up and treatment of female reproductive organs.
April 20, 2024
