What is dysmenorrhea?
Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.

• primary dysmenorrhea - from the beginning and usually lifelong; severe and frequent menstrual cramping caused by severe and abnormal uterine contractions.

• secondary dysmenorrhea - due to some physical cause and usually of later onset; painful menstrual periods caused by an another medical condition present in the body (i.e., pelvic inflammatory disease, endometriosis).

What causes dysmenorrhea?
The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, women 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

Who is at risk for dysmenorrhea?
While any woman can develop dysmenorrhea, the following women may be at an increased risk for the condition:

• women who smoke

• women who drink alcohol during menses (alcohol tends to prolong menstrual pain)

• women who are overweight

• women who started menstruating before the age of 11

Consult your physician for more information.

What are the symptoms of dysmenorrhea?
The following are the most common symptoms of dysmenorrhea. However, each individual may experience symptoms differently. Symptoms may include:

• cramping in the lower abdomen
• pain in the lower abdomen
• low back pain
• pain radiating down the legs
• nausea
• vomiting
• diarrhea
• fatigue
• weakness
• fainting
• headaches

The symptoms of dysmenorrhea may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

How is dysmenorrhea diagnosed?
Diagnosis begins with a gynecologist evaluating a patient’s medical history and a complete physical examination including a pelvic examination. A diagnosis of dysmenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, diagnostic procedures for dysmenorrhea may include the following:

• ultrasound - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.

• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

• laparoscopy - a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the physician can often detect abnormal growths.

• hysteroscopy - a visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.

Treatment for dysmenorrhea:
Specific treatment for dysmenorrhea will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• cause of the condition (primary or secondary)
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Counseling with your physician regarding symptoms may increase understanding and lead to activities for stress management. Other possible surgical and medical treatment protocols for managing dysmenorrhea symptoms may include:

• prostaglandin inhibitors, such as nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin and ibuprofen (to reduce pain)

• acetaminophen

• oral contraceptives (ovulation inhibitors)

• progesterone (hormone treatment)

• dietary modifications (to increase protein and decrease sugar and caffeine intake)

• vitamin supplements

• regular exercise

• heating pad across the abdomen

• hot bath or shower

• abdominal massage

• endometrial ablation - a procedure to destroy the lining of the uterus (endometrium).

• endometrial resection - a procedure to remove the lining of the uterus (endometrium).

• hysterectomy - surgical removal of the uterus.

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