Dysmenorrhea (Menstrual Pain): Definition And Treatment

Although it is normal to experiment pain during this phase of the menstrual cycle, the sharp or excessive pain can be a synonym of a condition known as dysmenorrhea. Throughout this article, we will talk about  what dysmenorrhea is and which are the symptoms, causes, and treatments  that are associated with it.

Dysmenorrhea (menstrual pain)

Dysmenorrhea consists of the appearance of painful episodes or colics during the menstruation period. This intense pain, which is usually sharp but can vary according to the woman who suffers it, often appears when the menstrual period starts and lasts about three days.

The pain is usually located in the pelvis or the lower part of the abdomen  and other symptoms, such as a backache, nausea, vomits, or diarrhea can be added to the pain.

In most of the cases, menstruation proceeds with mild or bearable discomfort. However, in women with dysmenorrhea, the pain can be so intense that it interferes with the person's daily routine and even requires medical attention.

While the menstrual pain suffered by young women is not usually synonymous with the existence of a significant problem (primary amenorrhea),  in adult women the pain may be a sign of an underlying problem such as uterine fibroids or endometriosis (secondary amenorrhea).

This condition is usually more frequent in women who have irregular periods that began before they were 12 years old or with low body weight. On the other hand, in those who exercise regularly or who have given birth at an early age, dysmenorrhea is usually much less common.

According to estimates, menstrual pain affects between 20% and 90% of women of reproductive age, rising as the most common menstrual disorder. In cases of primary dysmenorrhea, the pain usually subsides with age or after having a child.

Primary and secondary types

As we have mentioned previously, there are two different varieties of menstrual pain: primary and secondary.

Primary dysmenorrhea is a menstrual pain without an underlying clinical cause that causes it, but it is due to eventualities of the menstrual cycle itself.

As for the secondary type, it is used for those cases in which menstrual pain is an effect or symptom of another clinical condition or disease. Conditions that can cause secondary dysmenorrhea include:

• Endometriosis
• Pelvic inflammatory disease (PID)
• Stenosis or narrowing of the cervix
• The appearance of fibroids in the inner wall of the uterus

Symptoms

Menstrual pain is usually experienced as an intense, dull, sharp pain that causes cramps in the lower abdomen, just above the pelvic bone.

However, dysmenorrhea may be accompanied by other symptoms that are not as painful, but they are just as annoying. In the case that the symptoms worsen or appear in women older than 25 years old, it is advisable to go to the gynecologist's to rule out a possible underlying condition. These symptoms are:

• Pain in the lower back and thighs
• Nausea and vomit
• Feeling dizzy and fainting
• Diarrhea
• Constipation
• Swelling
• Migraines or headaches

Causes

The usual menstrual pain happens because, during menstruation,  the uterus undergoes a series of contractions that can be painful  and that are aimed at facilitating the expulsion of the uterine lining.

However, if the muscles contract excessively, it may end up pressing on nearby blood vessels, which cuts off the supply of oxygen to the uterus for a short period. This lack of oxygen is what causes the intense sensations of pain and cramps.

This pain caused by an eventuality or particular condition in the menstrual cycle, and that does not have an underlying clinical cause that causes it, is the primary dysmenorrhea.

About the secondary variety of this condition, as mentioned above, some clinical conditions cause menstrual pain, among which are endometriosis, adenomyosis or vertical stenosis.

Risk factors

In addition to the direct or indirect causes of menstrual pain, some risk factors can foment or boost the chances of developing this condition.

In particular, the main  risk factors for the appearance of dysmenorrhea  are:

• Be younger than 30.
• Early onset of puberty
• Menorrhagia or heavy bleeding during menstruation
• Irregular bleeding or metrorrhagia
• Family history of menstrual pain
• Smoking

Treatment

The pain caused by dysmenorrhea can become so intense that it may be necessary to resort to pharmacological treatment.

These are the main drugs recommended to relieve menstrual pain:

Painkillers

Some painkillers (including non-steroidal anti-inflammatories or NSAIDs such as ibuprofen or naproxen sodium), consumed in regular doses during menstruation, can significantly relieve menstrual pain.

Hormonal contraceptive control

Birth control pills contain a certain amount of hormones that prevent ovulation and reduce the intensity of dysmenorrhea.

In addition to pills, this drug can also be found in the form of patches, intrauterine devices, vaginal rings, implants under the skin or administered intravenously.

Surgery

In the case of secondary dysmenorrhea, caused by conditions such as endometriosis or fibroids, it may be necessary to resort to surgery in order to correct the underlying problems.

In cases of extremely intense pain, the surgical removal of the uterus can also be an alternative in case the other treatments do not work or if the woman does not plan to have children.

References

Osayande, A. S. & Mehulic, S. (2014). Diagnosis and initial management of dysmenorrhea. American Family Physician, 89(5): 341–346.

Rosenwaks, Z. & Seegar-Jones, G. (1980).Menstrual pain: its origin and pathogenesis. Journal of Reproductive Medicine, 25(4): 207–12.