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Dysmenorrhea
Also found under: Menstrual Disorders

What is it?
The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Dysmenorrhea is the term used to describe painful menstrual periods. There are two types of dysmenorrhea. Primary dysmenorrhea has no underlying cause. Secondary dysmenorrhea is caused by an underlying gynecological disorder.

Who gets it?
Primary dysmenorrhea affects more than 50 percent of all women who have a menstrual period. Approximately 5 to 15 percent of these women have severe pain that interferes with daily activities. Only about one-fourth of all women with dysmenorrhea have secondary dysmenorrhea, meaning there is an underlying cause of their symptoms. Dysmenorrhea usually begins during adolescence.

What causes it?
To understand dysmenorrhea, it's important to understand how the menstrual cycle works. Each month, the lining of the uterus, the endometrium, thickens to prepare for the egg that is released by the fallopian tubes. If the woman does not become pregnant during that cycle, then most of the endometrium is shed and bleeding occurs. The blood flows from the uterus, through the cervical canal, and out through the vagina. Primary dysmenorrhea occurs when the uterus contracts because the blood supply to the endometrium is reduced. This pain occurs only during a menstrual cycle where an egg is released. If the cervical canal is narrow, the pain may be worse as the endometrial tissue passes through the cervix. Pain can also be caused by a uterus that tilts backward instead of forward, low levels of physical activity, and emotional stress. Secondary dysmenorrhea can be caused by the growth of uterine tissue outside the uterus, called endometriosis; non-cancerous growths of muscle and fibrous tissue in the uterus, called fibroid tumors; the non-cancerous growth of the uterine lining in the muscular wall of the uterus, called adenomyosis; inflammation of the fallopian tubes; and the growth of scar tissue, or adhesions, between organs.

What are the symptoms?
Shortly before or in the beginning of the menstrual period, a woman with dysmenorrhea experiences cramps in the lower abdomen. The pain can be continuous, or may come and go, and may extend to the lower back and legs. The pain can be accompanied by headache, nausea, diarrhea or constipation, and the need to urinate frequently. In severe cases, dysmennorhea also causes vomiting and makes it difficult for the woman to participate in her normal activities. Symptoms are usually at their worst 24 hours after beginning, and stop after 2 days. Women with dysmenorrhea are more likely to pass blood clots from the lining of the uterus, which causes more pain.

How is it diagnosed?
To diagnose dysmenorrhea, your doctor will take a complete medical history and will perform a physical examination, including a pelvic, or internal, exam. This doctor would most likely be your gynecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. Fibroid tumors can usually be felt during a pelvic exam, but may need to be confirmed by an ultrasound scan of the abdomen. To make sure any growths are non-cancerous, your doctor may look inside the uterus using a hysteroscope, a small tube with a light that is inserted through the vagina and cervix and into the uterus. He or she may also look for abnormalities in the uterine tissue by removing a tiny sample of tissue from the inside of the uterus, called a biopsy, for examination under a microscope. Endometriosis is usually diagnosed through a combination of biopsy and laparoscopy. With laparoscopy, the doctor makes a small cut in the navel through which he or she inserts a small instrument called a laparoscope. With the laparoscope, the doctor can examine the uterus and other female organs, such as the fallopian tubes, in the pelvic area.

What is the treatment?
The treatment of dysmenorrhea depends on the cause of the problem. In most cases, symptoms are relieved by nonprescription anti-inflammatory drugs such as ibuprofren, naproxen, and mefanamic acid. If you know you have a history of dysmenorrhea, your doctor may recommend taking these medications up to two days before your menstrual period begins, and continuing them for one to two days after it begins. It's important to continue to get plenty of rest, follow a good diet, and exercise during your period. Women with primary dysmenorrhea that is so severe it interferes with daily activities may benefit from a low-dose birth control pill. Because birth control pills prevent an egg from being released each month, the menstrual period is generally lighter and lasts for a shorter time. Secondary dysmenorrhea is relieved by treating the cause. For example, fibroid tumors can be shrunk with hormone therapy, or may be surgically removed. Where fibroids are extremely large or cause severe pain, the entire uterus may need to be surgically removed. This procedure is called a hysterectomy, and is also used to treat severe endometriosis. A woman who has had a hysterectomy can no longer conceive a child. Inflammation of the fallopian tubes is treated with antibiotics.

Self-care tips
See your doctor if you have a pattern of severe pain at the beginning of and during your menstrual period. A thorough exam will help determine if your pain is caused by some underlying condition that may need immediate treatment. Remember, rest, diet, and exercise play an important role in your overall health, and may help relieve premenstrual and menstrual symptoms.

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.

**http://www.hmc.psu.edu/healthinfo/d/dysmenorrhea.htm