Dysmenorrhea is defined as prolonged pains and cramps in the lower abdomen and pelvis just before and during the first few days of the period. For many women, period pains can be severe enough to interfere with daily activities for a few days each month. Gynaecological conditions such as endometriosis or uterine fibroids may cause more severe dysmenorrhoea. Treating the cause is key to reducing and possibly eliminating the pain. Period cramps not caused by another gynaecological condition tend to decrease with increasing age and very often improve after childbirth.
Symptoms
- Very severe pain in the lower part of the abdomen
- Pain that starts 1 to 3 days before your period, peaks 24 hours after the start of your period and subsides in 2 to 3 days
- Pain reflected in the lower back and thighs
- Some women also experience nausea, diarrhea, headache, dizziness.
Causes
During your period, the uterus micro-contracts to help expel blood.
Prostaglandins involved in pain and inflammation trigger uterine muscle contractions. Higher levels of prostaglandins are associated with more intense menstrual cramps. Period cramps can be aggravated by:
- Endometriosis. Tissue that acts similar to the lining of the uterus grows outside the uterus, most commonly in the fallopian tubes, ovaries or the tissue that covers your pelvis, the peritoneum.
- Fibroids of the uterus.
- Adenomyosis. The tissue that covers your uterus starts to grow on the muscle walls of the uterus.
- Pelvic inflammatory disease. This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
- Cervical stenosis. In some women, the opening of the cervix is small enough to block menstrual flow, causing a painful increase in pressure in the uterus.
Complications
Dysmenorrhea does not usually cause other medical complications, but it can affect your daily life, school, work and social activities. However, some conditions such as endometriosis can cause fertility problems. Inflammatory pelvic disease can cause scarring of your fallopian tubes, increasing the risk of implanting a fertilised egg outside your womb (ectopic pregnancy).
Diagnosis
Your gynecologist will take your medical history and perform a physical examination, including a pelvic exam. During the pelvic exam, your pelvic exam checks for anything unusual with the reproductive organs and looks for signs of infection. Your doctor may also recommend certain tests, such as:
- Ultrasound of the internal genital organs
- CT scan.
- Magnetic resonance imaging
- Laparoscopy. Although it is usually not necessary to diagnose dysmenorrhea, laparoscopy can help detect an underlying condition such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy.
Treatment
To ease your period pain, your doctor may recommend:
- Pain Relief
Non-steroidal anti-inflammatory analgesics, such as ibuprofen or naproxen, in regular doses starting the day before your period starts, can help control the pain from cramps. Start taking the pain reliever at the beginning of your period or as soon as you feel symptoms, and continue to take the medicine as directed for two to three days or until your symptoms disappear.
- Hormones
Birth control pills containing hormones that prevent ovulation and reduce the severity of symptoms of dysmenorrhea. These hormones can also be given in several other forms: an injection, a skin patch, an implant that is placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD).
Lifestyle and assistive therapies
In addition to getting enough sleep and rest, you can if you want try to:
- Exercise regularly. Physical activity, including sex, helps relieve period cramps for some women.
- Use periodic heat. A warm bath or the use of a heating pad or hot water bottle on your lower abdomen can reduce period cramps.
- Try dietary supplements. A number of studies have shown that vitamin E, omega-3 fatty acids, vitamin B-1 (thiamine), vitamin B-6 and magnesium supplements can reduce menstrual cramps.
- Reduce stress. Psychological stress can increase the risk of menstrual cramps and their severity.
- Acupuncture
- Percutaneous electrical nerve stimulation (TENS).
- Herbal medicines. Certain herbal products, such as pycnogenol, fennel, may offer some relief from period cramps.
