Dysmenorrhea

Menstrual cramps (dysmenorrhea) are caused by the muscles of the uterus tightening (contracting) during a menstrual period. For some women, this discomfort is merely bothersome. For others, dysmenorrhea can be severe enough to interfere with everyday activities for a few days each month.

Primary dysmenorrhea is menstrual cramps that last a couple of days when you start having menstrual periods or soon after. This often begins after a teenager starts having her period. As a woman gets older or has a baby, the cramps will usually lessen or disappear. Secondary dysmenorrhea begins later in life, lasts longer, and the pain may be stronger than primary dysmenorrhea. The pain may start before the period and last a few days after the period.

CAUSES

Dysmenorrhea is usually caused by an underlying problem, such as:

  • The tissue lining the uterus grows outside of the uterus in other areas of the body (endometriosis).

  • The endometrial tissue, which normally lines the uterus, is found in or grows into the muscular walls of the uterus (adenomyosis).

  • The pelvic blood vessels are engorged with blood just before the menstrual period (pelvic congestive syndrome).

  • Overgrowth of cells (polyps) in the lining of the uterus or cervix.

  • Falling down of the uterus (prolapse) because of loose or stretched ligaments.

  • Depression.

  • Bladder problems, infection, or inflammation.

  • Problems with the intestine, a tumor, or irritable bowel syndrome.

  • Cancer of the female organs or bladder.

  • A severely tipped uterus.

  • A very tight opening or closed cervix.

  • Noncancerous tumors of the uterus (fibroids).

  • Pelvic inflammatory disease (PID).

  • Pelvic scarring (adhesions) from a previous surgery.

  • Ovarian cyst.

  • An intrauterine device (IUD) used for birth control.

RISK FACTORS

You may be at greater risk of dysmenorrhea if:

  • You are younger than age 30.

  • You started puberty early.

  • You have irregular or heavy bleeding.

  • You have never given birth.

  • You have a family history of this problem.

  • You are a smoker.

SIGNS AND SYMPTOMS

  • Cramping or throbbing pain in your lower abdomen.

  • Headaches.

  • Lower back pain.

  • Nausea or vomiting.

  • Diarrhea.

  • Sweating or dizziness.

  • Loose stools.

DIAGNOSIS

A diagnosis is based on your history, symptoms, physical exam, diagnostic tests, or procedures. Diagnostic tests or procedures may include:

  • Blood tests.

  • Ultrasonography.

  • An examination of the lining of the uterus (dilation and curettage, D&C).

  • An examination inside your abdomen or pelvis with a scope (laparoscopy).

  • X-rays.

  • CT scan.

  • MRI.

  • An examination inside the bladder with a scope (cystoscopy).

  • An examination inside the intestine or stomach with a scope (colonoscopy, gastroscopy).

TREATMENT

Treatment depends on the cause of the dysmenorrhea. Treatment may include:

  • Pain medicine prescribed by your health care provider.

  • Birth control pills or an IUD with progesterone hormone in it.

  • Hormone replacement therapy.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These may help stop the production of prostaglandins.

  • Surgery to remove adhesions, endometriosis, ovarian cyst, or fibroids.

  • Removal of the uterus (hysterectomy).

  • Progesterone shots to stop the menstrual period.

  • Cutting the nerves on the sacrum that go to the female organs (presacral neurectomy).

  • Electric current to the sacral nerves (sacral nerve stimulation).

  • Antidepressant medicine.

  • Psychiatric therapy, counseling, or group therapy.

  • Exercise and physical therapy.

  • Meditation and yoga therapy.

  • Acupuncture.

HOME CARE INSTRUCTIONS

  • Only take over-the-counter or prescription medicines as directed by your health care provider.

  • Place a heating pad or hot water bottle on your lower back or abdomen. Do not sleep with the heating pad.

  • Use aerobic exercises, walking, swimming, biking, and other exercises to help lessen the cramping.

  • Massage to the lower back or abdomen may help.

  • Stop smoking.

  • Avoid alcohol and caffeine.

SEEK MEDICAL CARE IF:

  • Your pain does not get better with medicine.

  • You have pain with sexual intercourse.

  • Your pain increases and is not controlled with medicines.

  • You have abnormal vaginal bleeding with your period.

  • You develop nausea or vomiting with your period that is not controlled with medicine.

SEEK IMMEDIATE MEDICAL CARE IF:

You pass out.