DYSMENORRHEA

General Information

DEFINITION--Severe, painful cramps during menstruation. Primary dysmenorrhea means pain has recurred regularly since periods began. Secondary dysmenorrhea means pain began years after periods started. Women with dysmenorrhea are generally fertile. Severity of symptoms varies greatly from woman to woman, and from one time to the next in the same woman. Dysmenorrhea usually is less severe after a woman has a baby.

BODY PARTS INVOLVED--Female reproductive system, especially the uterus.

SEX OR AGE MOST AFFECTED--Women of childbearing age.

SIGNS & SYMPTOMS

• Cramping and sometimes sharp pains in the lower abdomen, lower back and thighs.
• Nausea and vomiting (sometimes).
• Diarrhea (occasionally).
• Sweating; lack of energy.

CAUSES

• Strong or prolonged contractions of the muscular wall of the uterus. These may be caused by concentration of prostaglandins (hormones manufactured by the body). Research shows that women with dysmenorrhea produce and excrete more prostaglandins than those who don't have as much discomfort.
• Dilation of the cervix to allow passage of blood clots from the uterus to the vagina.
• Other causes include pelvic infections; endo-metriosis, especially if dysmenorrhea begins after age 20; benign tumors of the uterus.

RISK INCREASES WITH

• Use of caffeine.
• Stress. The degree of dysmenorrhea may vary according to physical or mental health. While emotional or psychological factors don't cause the pain, they can worsen pain or cause less responsiveness to treatment.
• Family history of dysmenorrhea.
• Lack of exercise.

HOW TO PREVENT

• Take female hormones that prevent ovulation, such as oral contraceptives.
• Treatment of the underlying cause.

What To Expect

DIAGNOSTIC MEASURES-- Medical history and physical exam, including a pelvic examination, by a doctor.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Initial treatment aims are to relieve pain. Long term goals of treatment involve treating any underlying cause with medication, counseling or possibly surgery.
• Transcutaneous electrical nerve stimulator (TENS) treatment may help relieve pain.
• Psychotherapy or counseling, if dysmenorrhea is stress-related. Hypnosis therapy may help.
• Treatment for the cause for secondary dysmenorrhea.

POSSIBLE COMPLICATIONS--Severe pain that regularly interferes with normal activity.

PROBABLE OUTCOME--Symptoms can be controlled with treatment.

How To Treat

GENERAL MEASURES--

• Heat helps relieve pain. Use a heating pad or hot-water bottle on the abdomen or back, or take hot baths. Sit in a tub of hot water for 10 to 15 minutes as often as necessary.
• Keep yourself warm. Women in cold environ-ments seem to suffer more severe symptoms.
• See How to Cope with Stress in Appendix for suggestions to reduce stress.

MEDICATION--

• For minor discomfort, you may use non-prescription drugs such as aspirin or ibuprofen.
• Your doctor may prescribe: Antiprostaglandins, including nonsteroidal, anti-inflammatory drugs. Oral contraceptives, which prohibit ovulation.

ACTIVITY--

• No restrictions. When resting in bed, elevate your feet or bend your knees; lie on your side.
• Regular, vigorous exercise reduces discomfort of future periods.

DIET--

• No special diet. Your doctor may prescribe vitamin-B supplements. These help relieve symptoms in some persons.
• Some herbal teas can relieve symptoms.
• Drink lots of nonalcoholic fluids.

Call Your Doctor If

• You have symptoms of dysmenorrhea you cannot control by yourself.
• Your bleeding is excessive (you saturate more than one pad or tampon each hour).
• You develop signs of infection, such as fever, a general ill feeling, headache, dizziness or muscle aches.
• New, unexplained symptoms develop.