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Dysmenorrhea - Types, Risk Factors, Cause, Signs, Symptoms, Diagnosis and Treatment

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Dysmenorrhea is the painful menstrual cramps affecting adults and teenagers. This article explains the causes, symptoms, diagnosis, and treatment for dysmenorrhea.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Megha Tuli

Published At May 30, 2022
Reviewed AtApril 1, 2023

What Is Dysmenorrhea?

Dysmenorrhea is referred to as painful cramps experienced in the lower abdomen before and during the periods. Mild discomfort or pain during menstruation is considered to be normal. And if there is excessive pain, then it is time for consultation.

What Are the Types of Dysmenorrhea?

Dysmenorrhea is of two types, primary and secondary.

  • Primary Dysmenorrhea: It is the recurrent lower abdominal pain or cramps that occur commonly during menstruation. This pain typically occurs a day or two before or during the onset of periods. Pain may vary from mild to severe, typically lasting 12 hours to 72 hours. Pain may be felt in the lower abdomen, thigh, or back. A few symptoms like nausea, vomiting, fatigue, and diarrhea are characteristic of dysmenorrhea. Menstrual cramps may reduce as you become old or even stop after the first pregnancy.

  • Secondary Dysmenorrhea: It is abdominal pain or cramps due to an infection in the female reproductive organ. Pain begins typically with menstruation and lasts even after the menstruation. Symptoms of primary dysmenorrhea like nausea, vomiting, fatigue, and diarrhea are not seen in this type. Still, they may have pain during intercourse, a large uterus, and resistance to effective treatment.

Who Is at Risk for Painful Menstruation?

The following factors increase the risk of painful menstruation:

  • Overweight.

  • Smoking.

  • Alcoholic (alcohol can prolong menstrual pain).

  • Women younger than age 30.

  • Early puberty at the age of 11 or younger.

  • Heavy bleeding during periods.

  • Irregular menstruation bleeding.

  • Family history of menstrual cramps.

  • Women who have not given birth.

What Are the Causes of Menstrual Cramps?

Menstrual cramps occur when a chemical called prostaglandin contracts the uterus. The uterus is a hollow muscular organ where the baby grows. If the uterus contracts strongly during the menstrual period, there is pressure against the nearby blood vessels, causing a cut-off oxygen supply. This lack of supply of oxygen to the uterus causes pain and cramps.

How Does Secondary Dysmenorrhea Cause Menstrual Cramps?

Any infections or problems in reproductive organs cause secondary dysmenorrhea. These are the conditions causing menstrual cramps.

  • Endometriosis: Endometriosis is when tissues lining the uterus grow outside the uterus, usually on the fallopian tubes, ovaries, or over the tissue lining the pelvis. These tissues bleed during menstruation, causing pain and swelling.

  • Uterine Fibroids: Fibroids in the uterus are non-carcinogenic growth inside, outside, or in the uterus walls, which causes abnormal menstruation or pain. Fibroid causes the uterus to become more prominent than usual, with increased and prolonged bleeding and pain.

  • Pelvic Inflammatory Disease (PIV) - It is an infection caused by sexually transmitted bacteria that starts in the uterus then gradually spreads to other organs like fallopian tubes and ovaries, causing pain and inflammation.

  • Cervical Stenosis: Cervical stenosis is a rare condition causing the cervix to be small or narrow because of scarring or lack of estrogen after menopause. Cervical stenosis may slow down the menstrual flow, which increases the pressure in the uterus leading to pain.

  • Premenstrual Syndrome: Premenstrual syndrome (PMS) is a common condition caused by hormonal changes. PMS normally occurs one to two weeks before menstruation, and symptoms leave after bleeding begins.

What Are the Signs and Symptoms of Dysmenorrhea?

The symptoms differ for each person. These are some common symptoms seen in women with dysmenorrhea.

  • Throbbing or cramping pain in the lower abdomen.

  • Pain in legs.

  • Lower back pain.

  • Nausea and vomiting.

  • Fatigue.

  • Headache.

  • Dizziness.

  • Cramping in the lower abdomen.

When to Consult a Doctor for Menstrual Pain?

Consult a doctor when,

  • Menstrual cramps or pain is so severe that your daily activity interferes with every month.

  • The onset of menstrual cramps after the age of 25 years.

  • Symptoms progressively worsen.

How Can Dysmenorrhea Be Diagnosed?

Diagnosis of painful menstrual cramps is carried out by evaluating the medical history and complete physical and pelvic examination. Doctors take the complete history of the menstrual cycle then perform a pelvic examination. Using their fingers, they feel any lumps or changes in the uterus and ovaries. Vaginal fluid samples may also be taken for testing. If there are any symptoms of secondary dysmenorrhea, doctors suggest further tests and treatments.

Below are the tests to be carried out to rule out the underlying disease.

  • Ultrasound Examination - The image of the internal organs are collected using high-frequency sound waves.

  • Laparoscopy - It is a minor procedure in which a laparoscope is used to see into the pelvic and abdomen area. A laparoscope is an instrument that is thin and has a lens and light attached to its tip, which helps find any abnormalities in the pelvic and abdominal area.

  • Magnetic Resonance Imaging (MRI) - This imaging technique provides detailed images of organs and structures within the body using large magnetic radio frequencies.

  • Hysteroscopy - Hysteroscope is an instrument used to insert into the vagina to visually examine the canal of the cervix and the inside of the uterus.

What Are the Home Remedies That Relieve Menstrual Cramps?

Several home remedies help in reducing painful menstrual cramps, which include:

  • Having a warm bath.

  • Massaging the abdomen with oil.

  • Using heating pads on the painful area.

Although these home remedies provide some relief,relying on it entirely is not advisable. It is always recommended to consult with a healthcare provider.

What Lifestyle Modifications Help Reduce Dysmenorrhea?

The following are a few lifestyle changes that help in reducing the intensity of dysmenorrhea:

  • Regular exercise and maintaining an average weight.

  • Health and nutritious diet.

  • Performing yoga and meditation.

  • Including supplements like vitamin B6, vitamin B1, vitamin E, omega-three fatty acid, calcium, and magnesium.

  • Reduced intake of salt and sugar.

  • Quit smoking and alcohol.

What Is the Treatment for Dysmenorrhea?

Treatment of dysmenorrhea depends on evaluating factors like age, health condition,

cause and extent of the disease, patient's tolerance for medications, and therapy. These are a few common medications prescribed by doctors:

  • Non-steroidal anti-inflammatory drugs (NSAIDs).

  • Pain killers.

  • Antidepressants - They regulate the mood swings associated with dysmenorrhea.

  • Hormonal Birth Control - These are available as a pill, patches, vaginal rings, implants, and injections which helps to prevent ovulation and control pain.

  • Surgery - It is the last option if other medical treatments are unsuccessful. It helps to remove uterine fibroids or cysts.

  • Hysterectomy - It is surgical removal of the uterus, which is carried out when all other treatment modalities do not help.

Conclusion:

Dysmenorrhea is expected due to lifestyle changes like increased junk food intake and reduced physical activity. If these painful cramps spoil your day-to-day activities it is advisable to consult a physician. Few lifestyle changes and medical treatment can reduce dysmenorrhea.

Frequently Asked Questions

1.

What Is the Leading Cause of Dysmenorrhea?

Dysmenorrhea occurs when a chemical called prostaglandin contracts the uterus. The uterus is a hollow muscular organ where the baby grows. If the uterus contracts intensely during the menstrual period, there is pressure against the nearby blood vessels, causing a cut-off oxygen supply. This lack of supply of oxygen to the uterus causes pain and cramps.

2.

Does Dysmenorrhea Cause Infertility?

Dysmenorrhea does not affect fertility. Most women with dysmenorrhea have primary dysmenorrhea caused by increased progesterone production that causes pelvic pain during menstruation. Primary dysmenorrhea is not associated with fertility. One in four women with dysmenorrhea has secondary dysmenorrhea. However, secondary dysmenorrhea may be due to an underlying gynecological cause. Some of these issues cause ovarian cysts and pelvic inflammatory diseases that may lead to infertility.

3.

Does Dysmenorrhea Lead to Death?

Normal period pain does not lead to death, but conditions with similar symptoms like dysmenorrhea may be fatal. If the period pain is more severe than usual, consult a doctor to ensure there is nothing wrong with the health.

4.

How Long Does Dysmenorrhea Last?

Dysmenorrhea pain can last 12 to 72 hours; it begins one or two days before the periods or when menstruation actually begins. The pain may range from mild to severe in the lower abdomen, thigh, or back.

5.

Is Dysmenorrhea a Common Condition?

Yes, dysmenorrhea is a normal part of many women's lives, and it can be recurrent in every menstrual cycle. It can be mild or severe and interfere with daily activities. If the pain is getting worse, there are treatments to cure dysmenorrhea.

6.

What Should Be Followed Before Periods to Avoid Dysmenorrhea?

Following a healthy lifestyle by doing regular exercise, taking a healthy diet, and drinking enough water can prevent dysmenorrhea to an extent. Also, try to take painkillers soon after the symptoms arise or after getting periods.

7.

What Is the Difference Between Primary and Secondary Dysmenorrhea?

Primary Dysmenorrhea: Primary dysmenorrhea is painful menstrual cramps without any pelvic pathology. Increased production of prostaglandins in the uterine lining cause uterine contractions; as a result, the endometrium sheds. When the level of prostaglandins decreases, menstrual cramps decreases.
Secondary Dysmenorrhea: Secondary dysmenorrhea is caused by disorders of pelvic organs, adenomyosis, endometriosis, congenital anomalies, or fibroids. This pain gradually increases over time.

8.

What Is the Difference Between Endometriosis and Dysmenorrhea?

Dysmenorrhea: Dysmenorrhea is a condition that causes severe and recurrent abdominal cramps and pains during menstruation. Uterine contractions happen due to increased production of prostaglandins in the uterine lining; as a result, the endometrium sheds. When there is a decrease in prostaglandins levels, menstrual cramps decreases.
Endometriosis: Endometriosis is a gynecological disorder; it occurs when the tissues lying inside the uterus proliferate and grows outside of the uterus. Symptoms are severe menstrual cramps, pain during intercourse, excessive bleeding, and infertility.

9.

Does Dysmenorrhea Feel Like Labor?

The contractions caused due to menstrual cramps are not as strong as labor pain. Instead, it is quite dull aching pain, but it may be severe in some women. During childbirth, the cervix opens up widely to pass the baby out, whereas, during menstruation, the cervix opens narrowly for the menstrual blood to flow.

10.

Is It Normal to Have Dysmenorrhea Every Month?

Dysmenorrhea is painful menstruation, which occurs every month, and is considered normal. Usually, around 50 percent of menstruating women have dysmenorrhea every month.

11.

How to Stop Dysmenorrhea Permanently?

Depending on the cause of dysmenorrhea, it might be possible to stop the pain permanently. Women who experience severe pain can consult the doctor. These are the treatments for dysmenorrhea.
Hormonal Contraception: Hormonal contraception available in oral tablets, inserted devices, and injections will be prescribed by doctors depending on the patient's condition.
Oral Contraceptives: Oral contraceptives prevent the ovaries from releasing an egg. Oral contraceptive pills are available in two varieties, a combined pill and a progesterone-only pill.
Progestin Devices: It is the synthetic type of progesterone hormone. Implantable rods, intrauterine devices, and contraceptive injections are a few types.

12.

How to Cure Dysmenorrhea Fastly?

Over-the-counter medicines like Ibuprofen, Acetaminophen, or Naproxen (Aleve) give immediate results for dysmenorrhea. Using a heat patch, massage with essential oils, hot showers, soaking in a hot bath, and vitamin and calcium supplements can also cure dysmenorrhea.

13.

What Is the Triggering Factor for Dysmenorrhea?

The following are the triggering factors of dysmenorrhea,
- Family history of dysmenorrhea.
- Women with too low or too high body weight.
- Women who smoke.
- Unhealthy food habits.
- Women who are stressed, anxious, or depressed.
- Women who have never had a baby before.

14.

Does Dysmenorrhea Occur Due to Hormonal Imbalance?

Dysmenorrhea is caused by the increased production of hormone-like lipids called prostaglandins that make the muscles and blood vessels of the uterus contract strongly to help get rid of its lining. Prostaglandins are also involved in pain and inflammation responses.

15.

Does Dysmenorrhea Cause Chronic Pain?

Primary dysmenorrhea can be mild or severe, can come back repeatedly, and are not due to other diseases. At the same time, secondary dysmenorrhea exhibits severe pain and occurs due to underlying pathology. So in cases of secondary dysmenorrhea, the pain will be chronic.
Dr. Megha Tuli
Dr. Megha Tuli

Obstetrics and Gynecology

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