Dysmenorrhea (Menstrual Cramps)
Dysmenorrhea is the medical name for the pain of severe and disabling menstrual cramps. Approximately 52% of women are affected by dysmenorrhea and about 10% of these are incapacitated each month for up to three days. The pain usually starts as menstruation starts, but mild cramping or lower abdominal pain may begin 24 to 48 hours before the flow begins. It may last only a few hours until the flow is well-established, but some women are troubled for several days.
There are two types of dysmenorrhea - primary and secondary dysmenorrhea. Primary dysmenorrhea is severe, disabling cramps without underlying illness. Symptoms may include backache, leg pain, nausea, vomiting, diarrhea, headache, and dizziness. This kind of dysmenorrhea usually affects young woman within two years of the onset of menstruation and lasts one or two days each month. Secondary dysmenorrhea is cramps caused by another medical problem(s) such as endometriosis (abnormalities in the lining of the uterus), adenomyosis (nonmalignant growth of the endometrium into the muscular layer of the uterus), pelvic inflammatory disease, uterine fibroids, cervical narrowing, uterine malposition, pelvic tumors or an IUD (intra-uterine device). This condition usually occurs in older women. Cramps When the menstrual cycle begins, prostaglandins (chemical substances that are made by cells in the lining of the uterus) are released by the endometrial cells as they are shed from the uterine lining, causing the uterine muscles to contract. If excessive prostaglandin is present, the normal contraction response can become a strong and painful spasm. As it spasms, the blood flow is cut off temporarily, depriving the uterine muscle of oxygen and thus causing a "cramp." The cramps themselves help push out the menstrual discharge. Excessive prostaglandin release is also responsible for contraction of the smooth muscle in the intestinal tract; hence the diarrhea, nausea and vomiting. Headache and dizziness may also be the result of high prostaglandin levels.
The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, females with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid - both chemicals which control the contractions of the uterus). Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis (a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity - often resulting in internal bleeding, infection, and pelvic pain). Other possible causes of secondary dysmenorrhea include the following: pelvic inflammatory disease (PID), uterine fibroids, abnormal pregnancy (i.e., miscarriage, ectopic), infection, tumors, or polyps in the pelvic cavity.
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.
For treatment of primary dysmenorrhea, most doctors prescribe antiprostaglandin drugs or NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen, ketoprofen, or naproxen. These drugs inhibit synthesis of prostaglandins, lessen the contractions of the uterus and reduce the menstrual flow. These drugs should be started at the onset of bleeding to avoid inadvertent use during early pregnancy and taken for 2-3 days. Oral contraceptives are another alternative. By stopping ovulation and decreasing prostaglandin levels, they may eliminate cramps. Treatment of secondary dysmenorrhea depends on the cause. Endometriosis is the most common cause of secondary dysmenorrhea. Depending on the stage of this disease and the woman's age and desire to have children, the treatment methods vary from conservative drug therapy (androgens, progestins, oral contraceptives and gonadotropin-releasing hormone agonists) to surgical procedures. If the problem is adenomyosis, a hysterectomy may be necessary. Pelvic inflammatory disease may be treated with antibiotics. Uterine fibroids, fibroid tumors and pelvic tumors are often treated surgically. Cervical narrowing can be corrected with surgery as well. Occasionally, an IUD (intra-uterine device) may be the cause, and if so, the doctor may prescribe antiprostaglandin drugs, and suggest removing the device and using another form of birth control.