2006-Jul-27
by JACK DANIELS

Dysmenorrhea is the occurrance of painful cramps during menstruation.

Description of Dysmenorrhea 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 of Dysmenorrhea 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 does not 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
• does not 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 of Dysmenorrhea A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps.

Treatment of Dysmenorrhea 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.

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