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Dysmenorrhea is a menstrual condition associated with pain and discomfort due to frequent and severe menstrual cramping. Dysmenorrhea comes in two forms which are either primary or secondary. Over half of all women have experienced it wherein 5% to 15% of them have extreme pain experiences that often interfere with normal daily functioning. About one-fourth of all women have experienced secondary dysmenorrhea due to underlying causes.


Primary dysmenorrhea is a symptom and not a disease. Dysmenorrhea is usually not considered a medical emergency although individuals are prompted to seek professional help when pain and discomfort becomes so great in which other activities of daily living cannot be done at all. The condition can last for 1 to 2 days every month together with the person’s menstrual cycle. Teenagers usually do not suffer from the condition since their uterus is still developing. Initial symptoms may start 1 to 2 days before menses then peak on the first day of flow. These will subside over the next few days. Some types of pain are manageable and tolerable so patients don’t need to skip days off school or work.

Pain is the most common symptom of the condition which can be described in a variety of ways. Some women consider the pain as sharp, dull, throbbing, radiating, burning, shooting or nauseating. The pain may also be coincided with heavy blood loss or menorrhagia. Pain is usually most severe during the first day of flow then gradually subsides a few days after. Cramping will manifest in the uterus and abdomen although those who had already given birth report milder symptoms.

Some women also report pain in the lower back, inner thighs and hips. Pressure seems to be accumulating in the abdomen together with an upset stomach, diarrhea and vomiting. Other associated symptoms include nausea, headache, fatigue, lack of energy, excessive sweating, urinary frequency, irritability, nervousness, restlessness, depression, passing of blood clots and blood tissue and dizziness. Primary dysmenorrhea pain is intermittent while secondary dysmenorrhea pain is known to last longer up to 2 to 3 days after the cycle stops. Some symptoms are present only in the secondary type such as very irregular menstruation and late onset of dysmenorrhea which as after 25 years of age.
Image: Dysmenorrhea


Primary dysmenorrhea is caused by strong uterine contractions triggered by high amounts of prostaglandin. A retroverted uterus may also predispose women to having primary dysmenorrhea every time. Lifestyle factors can contribute to the condition such as mental or emotional stress and lack of physical activity or exercise. Secondary dysmenorrhea may be caused by a variety of factors such as endomentriosis, uterine tumors like fibroids and adenomyosis, pelvic infection, hormonal imbalance, imperforated hymen and vaginal septum.

Prostaglandins are hormones responsible for pain responses and are usually produced in large quantities during menses leading to excess discomfort. More prostaglandins may also mean longer pain experiences for women. There are several other causes of dysmenorrhea such as being overweight, smoking, alcohol consumption, stress and being sedentary. Secondary dysmenorrhea generally occurs due to female reproductive system problems like disorders in the endometrium, ovarian tumors and pelvic inflammatory disease or PID wherein bacteria invades the uterus and fallopian tubes. Growth of scar tissue or adhesion between organs can also cause the disorder.

The endometrium normally thickens to prepare for conception. If conception does not result, most of the endometrial lining sheds off together with bleeding. When blood supply to the endometrium is minimized causing the uterus to contract, primary dysmenorrhea occurs. Pain occurs when an egg is released or if the cervical canal is too narrow giving a hard time for the endometrial tissue to pass through the cervix. The growth of uterine tissue outside the uterus causes secondary dysmenorrhea.


NSAIDs or non-steroidal anti-inflammatory drugs like ibuprofen and mefenamic acid are usually indicated to patients to control the production of prostaglandins to reduce muscle contraction in the uterus thereby inhibiting pain. These are usually given about 2 days before menses begins up to 2 days after the cycle ends. Oral contraceptive medications may also be used to inhibit ovulation, minimize menstrual flow and control uterine contractions. These are supposed to be taken daily and also add other beneficial effects like regulating menstrual flow and guaranteeing birth control.

Non-pharmaceutical treatment options include acupuncture and transcutaneous electrical nerve stimulation or TENS. These are known to help relieve pain and keep women relaxed. Vitamins and minerals may also be taken to reduce pain such as vitamin B1, magnesium supplements and iron to make up for excessive blood flow. Herbal concoctions based on chamomile, blueberry and mint are also found to be useful in relaxing muscles and relieving tension. Hot compresses on the abdomen can help minimize cramping and pain.

Chiropractics are also suggested to have beneficial effects on dysmenorrhea. The spine is placed in a very comfortable position thereby reducing symptoms like abdominal and lower back pain, headache and dizziness. Hormonal treatment may be indicated with the use of GnRH agonists, progestins and danazol.

Secondary dysmenorrhea is alleviated by treating the underlying cause of the problem. Surgical measures may be done to remove tumors and fibroids. Hysterectomy may be performed on patients with severe endometriosis. Bacterial infection is easily treated with the use of antibiotics. Regular checkup is important so that doctors can properly assign treatment approaches according to the patient’s menstrual cycle and specific responses. Severe forms of the condition may require interruption of the uterine nerves by dividing the sacrouterine ligaments surgically or through presacral neurectomy. Rest, diet and exercises are important to maximize the benefits.


A healthy lifestyle will help women prevent menstrual pain. They should eat a sound diet consisting of complex carbs, low-fat protein, fiber and essential fatty acids. Women should limit or avoid completely alcohol, smoking, fatty and sugary foods and caffeine. Regular exercise 3 to 4 times a week will help keep them from being overweight. Women should find means of relaxation to keep stress levels manageable.
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