Dysmenorrhea
Dysmenorrhea
Definition
Dysmenorrhea is the occurrence of painful cramps during menstruation .
Description
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. In fact, about 43 % of women in the United States suffer pain so severe that it disrupts their daily lives and about 18% miss one or more days or work, school, or other activities each year because of menstrual cramps.
Causes & symptoms
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 prostaglandins, hormone-like substances produced by uterine tissue, trigger strong muscle contractions in the uterus during menstruation. However, the level of prostaglandins does not seem to correlate 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 causes, such as diets , 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
- doesn't get enough exercise
- uses caffeine
- has pelvic inflammatory disease (PID)
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, although others do not notice a change.
Diagnosis
A doctor should perform a thorough pelvic exam and take a patient history to rule out any underlying condition that could cause cramps.
Treatment
Nutritional therapy
The following dietary changes may help prevent or treat menstrual pain:
- Increased dietary intake of foods such as fiber, calcium , soy foods, fruits and vegetables.
- Decreased consumption of foods that exacerbate PMS. They include caffeine, salt and sugar.
- Quitting smoking . Smoking has been found to worsen cramps.
- Taking daily multi-vitamin and mineral supplements that contain high doses of magnesium and vitamin B6 (pyridoxine ), and flaxseed or fish oil supplements. Recent research suggests that vitamin B supplements, primarily vitamin B6 in complex, magnesium, calcium, zinc, vitamin E , and fish oil supplements (omega-3 fatty acids ) also may help relieve cramps.
Herbal therapy
An herbalist may recommend one of the following herbal remedies for menstrual pain:
- Chasteberry (Vitex agnus-castus ) for women who also experience breast pain, irregular periods, and ovarian cysts.
- Dong quai (Angelica sinensis ) for women with typical menstrual pain.
- Licorice (Glycyrrhiza glabra ) for abdominal bloating and cramping.
- Black cohosh (Cimifuga racemosa ) for relief of menstrual pain as well as mood swing and depression.
Yoga
Several yoga positions are popular as methods to ease menstrual pain. In the "cat stretch" position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and buttocks.
Exercise
Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers.
Other remedies
Acupuncture and Chinese herbs are other popular alternative treatments for cramps. There are particular formulas depending on the pattern of imbalance. Aromatherapy and massage may ease pain for some women. Transcutaneous Electrical Nerve Stimulation (TENS) has been touted as a safe and practical way to relieve the pain of dysmenorrhea. It works by using electrodes to stimulate nerve fibers. Some women find relief through visualization, concentrating on the pain as a particular color and gaining control of the sensations. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods. Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position with knee pulled up to the chest while hugging a heating pad or pillow to the abdomen. Also, orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.
Allopathic treatment
Several drugs can lessen or completely eliminate the pain of primary dysmenorrhea. Most popular are the non-steroidal 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.
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.
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.
In 2002, an intrauterine device (IUD) was introduced to help eliminate the pain of menstrual cramps related to endometriosis. The IUD, known as Mirena, is approved for use in the Untied States as a contraceptive.
Expected results
Treatments should lessen or eliminate pain.
Prevention
Avoidance of caffeine, alcohol, and sugar prior to onset of period and NSAIDs taken a day before the period begins should eliminate cramps for some women.
Resources
BOOKS
Carlson, Karen J., Stephanie Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.
Murray, Michael T and Joseph E. Pizzorno. "Premenstrual syndrome." In Encyclopedia of Natural Medicine. Rev. 2nd ed. Rocklin, CA: Prima Publishing, 1998.
PERIODICALS
Hale, Ellen. "Taming menstrual cramps." FDA Consumer 25, no. 5 (June 1991): 26–29.
Harel, Z., et.al. "Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents." American Journal of Obstetrics and Gynecology 174 (April 1996): 13, 335–8.
McDonald, Claire, and Susan McDonald. "A Woman's Guide to Self-care." Natural Health (January–February 1998): 121–142.
"Menstrual Pain Severely Affects almost Half of U.S. Women." AORN Journal (April 2002): 121–778.
"More Power, Less Pain." Chemist & Druggist (April 6, 2002): 36.
"The Mirena IUD May Diminish Endometriosis –related Dysmenorrhea (Results of Two Small Studies)." OB GYN News (May 15 2002): 16.
ORGANIZATIONS
American College of Obstetricians and Gynecologists. 409 12th St. SW, Washington, DC 20024. (202) 638-5577.
Federation of Feminist Women's Health Centers. 633 East 11th Ave., Eugene, OR 97401. (503) 344-0966.
National Women's Health Network. 1325 G St. NW, Washington, DC 20005. (202) 347-1140.
Katy Nelson, N.D.
Dysmenorrhea
Dysmenorrhea
Definition
Dysmenorrhea refers to the pain or discomfort associated with menstruation . Although not a serious medical problem, the term describes a woman adolescent girl with menstrual symptoms severe enough to keep her from functioning for a day or two each month.
Description
Menstrual cramps are a common problem for adolescent girls and women. They may be mild, moderate, or severe and are the single most common cause of days missed from school and work. About 10 percent of girls are incapacitated for up to three days each month. Although many teens do not suffer from dysmenorrhea because their uterus is still growing, they may get it several years after their first period begins. The symptoms may begin one to two days before menses, peak on the first day of flow, and subside during that day or over several days.
Causes and symptoms
Primary dysmenorrhea is the more common type of dysmenorrhea and is due to the production of prostaglandins. Prostaglandins are natural substances made by cells in the inner lining of the uterus and other parts of the body. Those made in the uterus make the uterine muscles contract and help the uterus to shed the lining that has built up during the menstrual cycle. It appears, however, that the level of prostaglandins has nothing 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. Thus cramps must also be related to something other than prostaglandins, such as genetics, stress, and different body types. 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 during menstruation. Prostaglandins can also cause headaches, nausea , vomiting , and diarrhea . The likelihood that a woman will have cramps increases if the following apply to her:
- She has a family history of painful periods.
- She leads a stressful life.
- She does not get enough exercise .
- She uses caffeine .
- She has pelvic inflammatory disease.
Primary dysmenorrhea usually presents during adolescence , within three years of menarche. It is unusual for symptoms to start within the first six months after menarche. Affected young women experience sharp, intermittent spasms of pain, usually centered in the suprapubic area. Pain may radiate to the back of the legs or the lower back. Systemic symptoms of nausea, vomiting, diarrhea, fatigue, fever , headache , or lightheadedness are fairly common. Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle. Some women notice that painful periods disappear after having their first child. This could be due to the stretching of the opening of the uterus or the fact that birth improves the uterine blood supply and muscle activity.
Secondary dysmenorrhea is defined as menstrual pain due to pelvic pathology. This condition usually occurs after a woman has had normal menstrual periods for some time. It differs from primary dysmenorrheal in that the pain is caused by an abnormality or disease of the uterus, tubes, or ovaries. The most common causes are:
- pelvic inflammatory disease
- fibroids (intracavitary or intramural)
- intrauterine contraceptive devices
- endometriosis
- inflammation and scarring(adhesions)
- functional ovarian cysts
- benign or malignant tumors of ovary, bowel or bladder, or other site
- inflammatory bowel disease
Diagnosis
A focused history and physical examination are usually sufficient to make the diagnosis of primary dysmenorrhea. The history reveals the typical cramping pain with menstruation, and the physical examination is completely normal. A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps. It is usually possible to differentiate dysmenorrhea from premenstrual syndrome (PMS) based on the patient's history. The pain associated with PMS is generally related to breast tenderness and abdominal bloating, rather than a lower abdominal cramping pain. PMS symptoms begin before the menstrual cycle and resolve shortly after menstrual flow begins.
Circumstances that may indicate secondary dysmenorrheal include the following:
- dysmenorrhea occurring during the first one or two cycles after menarche (congenital outflow obstruction)
- dysmenorrhea beginning after 25 years of age
- late onset of dysmenorrhea after a history without previous pain with menstruation (possibly caused by complications of pregnancy: ectopic or threatened spontaneous abortion)
- pelvic abnormality on physical examination; infertility (possible endometriosis, pelvic inflammatory disease or other causes of scarring); heavy menstrual flow or irregular cycles (consider adenomyosis, fibroids, polyps); dyspareunia
- little or no response to therapy with nonsteroidal anti-inflammatory drugs , oral contraceptives , or both
Treatment
Secondary dysmenorrhea is controlled by treating the underlying disorder.
The appropriate choice of therapy for most women with primary dysmenorrheal is a nonsteroidal anti-inflammatory drug (NSAIDs), which prevents the formation and release of prostaglandins. Aspirin is not used for the treatment of dysmenorrheal because it is not potent enough in the usual dosage. Response to NSAIDs usually occurs within 30 to 60 minutes, but since individual response may vary, it is sometimes necessary to try different NSAIDs if the pain is not relieved with the first drug after one or two menstrual cycles. The NSAIDs include ibuprofen, naproxen (Aleve), and Motrin.
If an NSAID is not available, acetaminophen (Tylenol) may help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help. Birth control pills are 90 percent effective in easing the pain of dysmenorrheal. They work by a twofold action: they reduce the menstrual fluid volume and suppress ovulation. They are generally not prescribed initially because it is a daily medication unless the woman also wants a birth control method. They may be chosen as a first line of therapy.
Alternative treatment
Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are popular ways to ease menstrual pain. In the "cat stretch," position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies on her back with knees bent and then lifts the pelvis and buttocks.
Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Some research suggests that vitamin B supplements, primarily vitamin B6 in a complex, magnesium, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.
Other women find relief through visualization, concentrating on the pain as a particular color, and gaining control of the sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods.
Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.
Acupuncture and Chinese herbs are additional alternative treatments for cramps.
Prognosis
Medication should lessen or eliminate pain by the end of three menstrual cycles. If it does not work, then a re-evaluation is necessary.
Prevention
NSAIDs taken one to two days before a period begins should eliminate cramps for some women.
KEY TERMS
Adenomyosis —Uterine thickening caused when endometrial tissue, which normally lines the uterus, extends outward into the fibrous and muscular tissue of the uterus.
Endometriosis —A condition in which the tissue that normally lines the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and frequently, infertility.
Hormone —A chemical messenger secreted by a gland or organ and released into the bloodstream. It travels via the bloodstream to distant cells where it exerts an effect.
Ovary —One of the two almond-shaped glands in the female reproductive system responsible for producing eggs and the sex hormones estrogen and progesterone.
Ovulation —The monthly process by which an ovarian follicle ruptures releasing a mature egg cell.
Progesterone —The hormone produced by the ovary after ovulation that prepares the uterine lining for a fertilized egg.
Uterus —The female reproductive organ that contains and nourishes a fetus from implantation until birth. Also called the womb.
Resources
BOOKS
Carlson, K. J., et al. The New Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 2004.
ORGANIZATIONS
National Women's Health Network. 514 10th St. NW, Suite 400, Washington, DC 20004. Web site: <www.womenshealthnetwork.org>.
WEB SITES
Clark, Alan D. "Dysmenorrhea." eMedicine, October 12, 2004. Available online at <http://www.emedicine.com/emerg/topic156.htm> (accessed December 21, 2004).
Linda K. Bennington
Dysmenorrhea
Dysmenorrhea
Definition
Dysmenorrhea is the occurrance of painful cramps during menstruation.
Description
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
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
A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps.
Treatment
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.
Alternative treatment
Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are popular ways to ease menstrual pain. In the "cat stretch," position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and buttocks.
Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Recent research suggests that vitamin B supplements, primarily vitamin B6 in a complex, magnesium, and fish oil supplements (omega-3 fatty acids ) also may help relieve cramps.
Other women find relief through visualization, concentrating on the pain as a particular color and gaining control of the sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods.
Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.
Acupuncture and Chinese herbs are another popular alternative treatments for cramps.
Prognosis
Medication should lessen or eliminate pain.
Prevention
NSAIDs taken a day before the period begins should eliminate cramps for some women.
Resources
PERIODICALS
McDonald, Claire, and Susan McDonald. "A Woman's Guide to Self-care." Natural Health January-February 1998:121-142.
ORGANIZATIONS
National Women's Health Network. 514 10th St. NW, Suite 400, Washington, DC 20004. (202) 628-7814. 〈http://www.womenshealthnetwork.org〉.
KEY TERMS
Endometriosis— The growth of uterine tissue outside the uterus.
Hormone— A chemical messenger secreted by a gland and released into the blood, which allows it to travel to distant cells where it exerts an effect.
Ovary— One of the two almond-shaped glands in the female body that produces the hormones estrogen and progesterone.
Ovulation— The monthly release of an egg from an ovary.
Progesterone— The hormone produced by the ovary after ovulation that prepares the uterine lining for a fertilized egg.
Uterus— The female reproductive organ that contains and nourishes a fetus from implantation until birth.