Dysmenorrhea

Nearly all women experience some cramping during menstrual periods, but not all require medical treatment. Many continue normal activities with the help of ordinary pain medications, such as Acetaminophen (eg: Tylenol) or Ibuprofen (eg: Advil).

A smaller number of women experience more severe pain that interferes with normal day-to-day activities. Menstrual pain when severe is called dysmenorrhea.

There are two kinds of dysmenorrhea:

1. Primary Dysmenorrhea
2. Secondary Dysmenorrhea

Primary dysmenorrhea usually occurs in younger women, in the first few years after the onset of puberty. This is a major cause of absenteeism among teenage girls. The pain is caused by excessive production of prostaglandins, which is a substance normally produced during menstrual flow. The pain is worst during the first couple of days, and occurs in the lower abdomen, lower back and thighs, and may be accompanied by nausea, vomiting, headache and diarrhea.

Secondary dysmenorrhea is due a physical abnormality in the pelvic organs and usually starts at a later age. Most commonly it is caused by a condition called endometriosis, which is the presence of endometrium (inner lining of the uterus) outside the uterus. When menstruation starts, bleeding occurs at the sites of endometriosis, causing pain. A variant of endometriosis is called Adenomyosis, where the endometrium is found between the muscle fibers of the uterus.

Other causes of secondary dysmenorrhea include Pelvic Inflammatory Disease, Fibroids, Polyps, etc. Some IUDs also cause dysmenorrhea.

Diagnosis: In many instances the doctor can diagnose the cause of the dysmenorrhea by a detailed description of the pain and by a simple physical examination. For example, painful menstruation in a young teenager, starting in the first 1-2 years of puberty, with a normal physical exam, is due to primary dysmenorrhea.

Other diagnostic tools include ultrasound exam (sonography), MRI and some minimally invasive operative procedures, such as laparoscopy and hysteroscopy. Operative procedures, even when minimally invasive, are used only as a last resort.

Treatment: Choice of treatment depends on the cause of dysmenorrhea and the severity of symptoms.

Very often simple lifestyle changes such as aerobic exercises, smoking cessation, abstaining from alcohol, weight loss and dietary changes are helpful. Hot bath or shower and a heating pad across the lower abdomen are also helpful. Relaxation exercises, such as yoga, is also known to help.

If the physical examination is normal Ibuprofen in prescription doses is prescribed. Ibuprofen works best if taken at the earliest sign of pain. Self medication in these doses with over-the-counter Ibuprofen without physician supervision is discouraged due to side effects.

Birth Control Pill usually reduces menstrual pain and may be tried as the next line of treatment, if there are no contraindications. For example, smokers and those with a history of abnormal clotting of blood cannot take the birth control pill.

If the above measures are not helpful or if an abnormality is found during the exam, further testing and treatment may be necessary.

Other source of information: American College of Obstetricians & Gynecologists.

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