Dysmenorrhea

Dysmenorrhea is the occurrance of painful cramps during menstruation.

Description

More than half of all girls and women suffer from dysmenorrhea (cramps), a dull or throbbing pain that usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps.

While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month.

Causes and symptoms

Dysmenorrhea is called "primary" when there is no specific abnormality, and "secondary" when the pain is caused by an underlying gynecological problem. It is believed that primary dysmenorrhea occurs when hormone-like substances called "prostaglandins" produced by uterine tissue trigger strong muscle contractions in the uterus during menstruation. However, the level of prostaglandins doesn't seem to have anything to do with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts assume that cramps must also be related to other things (such as genetics, stress, and different body types) in addition to prostaglandins. The first year or two of a girl's periods are not usually very painful. However, once ovulation begins, the blood levels of the prostaglandins rise, leading to stronger contractions.

Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the pelvis.

The likelihood that a woman will have cramps increases if she:

• has a family history of painful periods
• leads a stressful life
• doesn't get enough exercise
• uses caffeine
• has pelvic inflammatory disease

Symptoms include a dull, throbbing cramping in the lower abdomen that may radiate to the lower back and thighs. In addition, some women may experience nausea and vomiting, diarrhea, irritability, sweating, or dizziness. Cramps usually last for two or three days at the beginning of each menstrual period. Many women often notice their painful periods disappear after they have their first child, probably due to the stretching of the opening of the uterus or because the birth improves the uterine blood supply and muscle activity.

Diagnosis

A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps.

Treatment

Secondary dysmenorrhea is controlled by treating the underlying disorder.

Several drugs can lessen or completely eliminate the pain of primary dysmenorrhea. The most popular choice are the nonsteroidal anti-inflammatory drugs (NSAIDs), which prevent or decrease the formation of prostaglandins. These include aspirin, ibuprofen (Advil), and naproxen (Aleve). For more severe pain, prescription strength ibuprofen (Motrin) is available. These drugs are usually begun at the first sign of the period and taken for a day or two. There are many different types of NSAIDs, and women may find that one works better for them than the others.

If an NSAID is not available, acetaminophen (Tylenol) may also help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help. While birth control pills will ease the pain of dysmenorrhea because they lead to lower hormone levels, they are not usually prescribed just for pain management unless the woman also wants to use them as a birth control method. This is because these pills may carry other more significant side effects and risks.

New studies of a drug patch containing glyceryl trinitrate to treat dysmenorrhea suggest that it also may help ease pain. This drug has been used in the past to ease preterm contractions in pregnant women.

Alternative treatment

Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are popular ways to ease menstrual pain. In the "cat stretch, " position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and buttocks.

Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Recent research suggests that vitamin B supplements, primarily vitamin B₆ in a complex, magnesium, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.

Other women find relief through visualization, concentrating on the pain as a particular color and gaining control of the sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods.

Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.

Acupuncture and Chinese herbs are another popular alternative treatments for cramps.

Prognosis

Medication should lessen or eliminate pain.

Prevention

NSAIDs taken a day before the period begins should eliminate cramps for some women.