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Dysmenorrhea by Diane W. Shannon, MD, MPH

Definition

Dysmenorrhea is painful menstruation. It may include pain in the abdomen, back and legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their life. In some women, the pain is severe enough to interfere with normal activities.

There are two types of dysmenorrhea:

Primary dysmenorrhea—painful regular (ovulatory) menstrual cycles; the pain is caused by utrine muscle contractions caused by high levels of prostaglandins produced in the lining and body of the uterus after ovulation.
Secondary dysmenorrhea—painful periods due to an underlying condition, such as endometriosis (a condition involving the lining of the uterus or womb) or infection, that can begin at any age

Menstrual Flow

Causes

Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.

Secondary dysmenorrhea can be caused by:

Endometriosis
Ovarian cysts
Pelvic inflammatory disease (infection of the female reproductive organs)
Uterine fibroids (noncancerous growths in the uterus)
Intrauterine contraceptive devices (IUDs)
Scars inside the abdomen from previous surgery
Tumors
Inflammatory bowel disease

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for primary dysmenorrhea include:

Ovulatory menstrual cycles ( a normal physiologic condition)
Age: less than 20 years old
Early onset of menstruation (less than 12 years old)
Depression or anxiety
Attempts to lose weight (in women 14-20 years old)
Heavy bleeding during periods
Nulliparity (never having delivered a baby)
Smoking

The presence of a known cause of secondary dysmenorrhea (see “Causes”) is a risk factor for developing the condition.

Symptoms

The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing or dull and aching, depending on the individual. It is most typically located in the lower abdomen and may radiate to the low back or thighs. Other symptoms may include:

Nausea
Vomiting
Diarrhea
Headache
Irritability

Diagnosis

Your doctor will ask detailed questions about your symptoms and medical history, and perform a pelvic examination.

Diagnostic tests may include:

Pelvic ultrasound —a test that uses sound waves to examine structures in the pelvis
Pelvic laparoscopy —a thin, lighted tube inserted through a small incision in the abdomen to view structures in the pelvis

These tests are usually performed to look for causes of secondary dysmenorrhea.

Treatment

The treatment of secondary dysmenorrhea varies depending on the underlying condition (for example, antibiotics for an infection or surgery to remove fibroids).

Primary dysmenorrhea is usually treated with medications and lifestyle changes.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDS)
Oral contraceptives

Other Treatments

Using a heating pad on your abdomen or taking a warm bath can relieve discomfort.
Some herbs and supplements may be helpful, such as B1 , magnesium , and Chinese Herbal Medicine .
- Talk to your doctor before taking any herbs and supplements. They may interact with your other medications and conditions.
Acupuncture can reduce pain.

If you are diagnosed with dysmenorrhea, follow your doctor's instructions .

Prevention

To help reduce your chance of getting dysmenorrhea, take the following steps:

Exercise regularly.
If you smoke, quit .
Drink only moderate amounts of caffeine and alcohol.

RESOURCES:

American Academy of Family Physicians http://www.aafp.org
Women's Health.gov http://www.4woman.gov/

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org
Women's Health Matters http://www.womenshealthmatters.ca/index.cfm

References:

Coco AS. Primary dysmenorrhea. Am Fam Physician . 1999;60:489-496.
Dysmenorrhea: painful menstrual periods. American Academy of Family Physicians website. Available at: http://www.familydoctor.org/829.xml?printxml . Accessed August 10, 2005.
French L. Dysmenorrhea. Am Fam Physician . 2005;71:285-291.
Menstrual cramps (dysmenorrhea). Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=DS00506 . Accessed August 12. 2005.
Speroff L. Clinical Gynecologic Endocrinology and Infertility. 6th ed. Baltimore, MD: Lippincott Williams & Wilkins; 1999.
¹9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008;198:166.e1-8.

Last reviewed November 2008 by Adrienne Carmack, MD

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