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Dysmenorrhea - Painful Periods 

Introduction
Dysmenorrhea is the medical term for very painful menstrual cramps.  All females may experience cramps at one time or another, but for those with dysmenorrhea, severe pain and stomach problems may interfere with their daily activities.  Dysmenorrhea may or may not be caused by an underlying condition, such as endometriosis or fibroids.  There are many treatments to help dysmenorrhea, including self-care measures, medications, or surgery to treat the underlying causes.

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Anatomy
The menstrual cycle is a regular process that is regulated by hormones.  The average menstrual cycle lasts around 28 days, but it varies among individuals and may be either longer or shorter.  Each month the uterine lining thickens as it builds up extra blood and tissue in preparation for a potential fertilized egg.  An egg that is fertilized by a sperm cell may implant itself in the nourishing uterine lining and develop into a baby.  An unfertilized egg or a fertilized egg that does not implant in the uterus passes through the reproductive system.  During menstruation prostaglandins, a hormone-like substance, cause the uterus to contract.  The uterine lining sheds and the blood leaves the body through the vagina.

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Causes
Dysmenorrhea is classified as primary or secondary.  Primary dysmenorrhea is not caused by an underlying condition.  It usually begins three to four years after a female has started menstruating.  It is suspected that prostaglandins may contribute to painful cramps by creating greater uterine contractions.  Primary dysmenorrhea usually decreases with age and disappears after childbirth.
 
An underlying medical condition or disease causes secondary dysmenorrhea.  It usually begins when women are in their twenties.  Secondary dysmenorrhea may be caused by a physical condition, such as uterine fibroids, uterine polyps, ovarian cysts, or endometriosis.  Sexually transmitted diseases, pelvic inflammatory disease, or an intrauterine device (IUD) are other causes.

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Symptoms
Dysmenorrhea causes severe painful cramps in the lower abdomen.  It may be a sharp pain that comes and goes or a dull aching pain.  Pain may be felt in the back and legs.  Pain usually begins one or two days before a period begins and lasts for one or two days into the period.  Dysmenorrhea may cause stomach problems, including nausea, vomiting, diarrhea, and constipation.  It may also cause sweating or dizziness.  For some people, severe symptoms prevent participation in daily activities, such as going to work or school.

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Diagnosis
To help diagnose dysmenorrhea, your doctor will review your medical history and conduct a physical and pelvic examination.  Determining the cause of secondary dysmenorrhea is important for treatment planning.  Your doctor will check your reproductive organs for any structural abnormalities or signs of infection.  Samples of your vaginal cells may be collected to identify sexually transmitted diseases.

Imaging tests or special procedures may be used to look for abnormal growths or conditions.  Ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans may be used to create pictures of your internal pelvic structures.  A laparoscopy is a surgical procedure that allows your doctor to view your pelvic cavity.  It involves inserting a thin tube with a lighting device through a small incision in your abdomen.  A laparoscopy is an outpatient test that uses general anesthesia.  A hysteroscopy uses a viewing instrument that is inserted through your vagina and cervix to examine the inside of the uterus.

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Treatment
Treatment for dysmenorrhea may depend on the extent of your symptoms and if you have primary or secondary dysmenorrhea.  In some cases, self-care measures may help relieve your symptoms.  You may want to try placing a heating pad on your abdomen or soaking in a hot bath.  It is important to get plenty of rest and relaxation.  Regular exercise is helpful to release endorphins, your body’s natural painkillers.  It may be helpful to participate in stress-relieving activities, such as massage or yoga.  Vitamins B-6, calcium, and magnesium may help prevent pain associated with PMS.  In 1998 the National Institutes of Health issued a statement that acupuncture may help relieve menstrual pain.

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) including, aspirin, ibuprofen, or naproxen, may help relieve pain.  Your doctor may prescribe low dose birth control pills for 6 to 12 months to help reduce the production of prostaglandins.

Treatment for the underlying cause of secondary dysmenorrhea depends on the type of condition or disease.  Cysts, polyps, fibroids, and endometriosis may be removed with surgery.  Antibiotics are used to treat sexually transmitted diseases.  An IUD may be removed if it is causing pain. 

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Prevention
You may be able to prevent secondary dysmenorrhea by avoiding contact with sexually transmitted diseases.  This can be achieved by abstinence.  Female or male condoms may help reduce the spread of some types of sexually transmitted diseases.

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Am I at Risk

Risk factors may increase your likelihood of developing dysmenorrhea, although some people that develop the condition do not have any risk factors.  People with all of the risk factors may never develop the dysmenorrhea; however, the chance of developing the condition increases with the more risk factors you have.  You should tell your doctor about your risk factors and discuss your concerns. 


Risk factors for dysmenorrhea:


_____ Females with an early onset of puberty (before 11 years old) have an increased risk of developing dysmenorrhea.
_____ A family history of dysmenorrhea increases your risk for the condition.
_____ Endometriosis is a cause of secondary dysmenorrhea.
_____ Pelvic inflammatory disease (PID) is an infection of the female reproductive organs that is caused by sexually transmitted bacteria.  PID can cause secondary dysmenorrhea.
_____ Uterine fibroids or polyps can cause secondary dysmenorrhea.
_____ Ovarian cysts can cause secondary dysmenorrhea.
_____ Premenstrual syndrome (PMS) may contribute to dysmenorrhea.

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Complications
Severe dysmenorrhea may cause severe symptoms that impair a female’s ability to participate in her daily activities.  Severe dysmenorrhea is a leading cause of work or school absence for females.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.