Definition

Dysmenorrhea is painful menstruation. It may include pain in the abdomen, back and legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their life. In some women, the pain is severe enough to interfere with normal activities.

There are two types of dysmenorrhea:

• Primary dysmenorrhea—painful regular (ovulatory) menstrual cycles; the pain is caused by utrine muscle contractions caused by high levels of prostaglandins produced in the lining and body of the uterus after ovulation.
• Secondary dysmenorrhea—painful periods due to an underlying condition, such as endometriosis (a condition involving the lining of the uterus or womb) or infection, that can begin at any age

Menstrual Flow

© 2009 Nucleus Medical Media, Inc.

Causes

Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.

Secondary dysmenorrhea can be caused by:

• Endometriosis
• Ovarian cysts
• Pelvic inflammatory disease (infection of the female reproductive organs)
• Uterine fibroids (noncancerous growths in the uterus)
• Intrauterine contraceptive devices (IUDs)
• Scars inside the abdomen from previous surgery
• Tumors
• Inflammatory bowel disease

Risk Factors

Risk factors for primary dysmenorrhea include:

• Ovulatory menstrual cycles ( a normal physiologic condition)
• Age: less than 20 years old
• Early onset of menstruation (less than 12 years old)
• Depression or anxiety
• Attempts to lose weight (in women 14-20 years old)
• Heavy bleeding during periods
• Nulliparity (never having delivered a baby)
• Smoking

The presence of a known cause of secondary dysmenorrhea (see “Causes”) is a risk factor for developing the condition.

Symptoms

The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing or dull and aching, depending on the individual. It is most typically located in the lower abdomen and may radiate to the low back or thighs. Other symptoms may include:

• Nausea
• Vomiting
• Diarrhea
• Headache
• Irritability

Diagnosis

Your doctor will ask detailed questions about your symptoms and medical history, and perform a pelvic examination.

Diagnostic tests may include:

• Pelvic ultrasound —a test that uses sound waves to examine structures in the pelvis
• Pelvic laparoscopy —a thin, lighted tube inserted through a small incision in the abdomen to view structures in the pelvis

These tests are usually performed to look for causes of secondary dysmenorrhea.

Treatment

The treatment of secondary dysmenorrhea varies depending on the underlying condition (for example, antibiotics for an infection or surgery to remove fibroids).

Primary dysmenorrhea is usually treated with medications and lifestyle changes.

If you are diagnosed with dysmenorrhea, follow your doctor's instructions .

Prevention

To help reduce your chance of dysmenorrhea, take the following steps:

• Exercise regularly.
• If you smoke, quit.
• Drink only moderate amounts of caffeine and alcohol.