Dysmenorrhea

DYSMENORRHEA

Dysmenorrhea is the medical term that describes pain with menstruation. There are two types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea is common menstrual cramps that are recurrent (come back) and are not due to other diseases. Pain either begins 1 or 2 days before, or begins when menstrual bleeding starts. It is felt in the lower abdomen, back, or thighs. The pain can range from mild to severe, and can typically last 12 to 72 hours. The cramps can be accompanied by nausea-and-vomiting, fatigue, and sometimes even diarrhea. Common menstrual cramps usually become less painful as a woman ages and in many cases, stop entirely if the woman has a baby.

Secondary dysmenorrhea is pain that is caused by a disorder in the woman's reproductive organs, (e.g. endometriosis, Adenomyosis, uterine fibroids, or infections). The pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.

CAUSES OF DYSMENORRHEA

Identifying the cause(s) of painful menstrual periods is not always possible. The fact is that some people are just at a higher risk of having painful menstrual periods.

These risks include:

• Not ever having had a baby
• Having irregular periods
• Having early puberty before age 11
• Being under the age of 20
• Coming from a family with the history of painful periods
• Being a smoker
• Having heavy bleeding during periods

Prostaglandin which is a hormone triggers muscle contractions in the uterus that expel the lining. The level of prostaglandin rises right before menstruation begins. This can cause pain and inflammation.

Painful menstrual periods can also be the result of underlying medical conditions, such as:

Premenstrual syndrome (PMS) - PMS is a common condition that is caused by hormonal changes in a woman's body, it occurs 1 to 2 weeks before menstruation begins. Symptoms typically go away after bleeding begins.

Endometriosis : Cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis. It is a rather painful medical condition.

Fibroids in the uterus - Fibroids can put pressure on the uterus or cause abnormal menstruation and pain, though they often hardly cause symptoms.

Pelvic inflammatory disease (PID) - Often caused by sexually transmitted bacteria that cause inflammation of the reproductive organs and some pain, PID is an infection of the uterus, fallopian tubes, or ovaries.

Adenomyosis - This condition is very rare. The uterine lining grows into the muscular wall of the uterus, causing inflammation, pressure, and pain. It is also capable of causing longer or heavier periods.

Cervical stenosis - A rare condition in which the cervix is so small or narrow that it slows menstrual flow. This causes an increase of pressure inside the uterus which causes pain.

SYMPTOMS OF DYSMENORRHEA

Symptoms of menstrual cramps include:

• Pain that starts 1 to 3 days before one's menstrual period, peaks 24 hours after the onset of the period and subsides in 2 to 3 days.
• A sharp pain that radiates to the lower back and thighs
• An intense throbbing or cramping pain in the lower abdomen.
• A dull, continuous ache

Some women also have:

• Dizziness
• Headache
• Nausea
• Loose stools

WHEN TO SEE A DOCTOR

If menstrual pain is interfering with the ability to perform basic tasks each month, it may be time to talk to a gynecologist.

Talk to a doctor if symptoms such as the following is experienced:

• A Continuing pain after IUD placement
• One has at least three painful menstrual periods
• One Passes blood clots
• The cramping is accompanied by diarrhea and nausea
• Pelvic pain when not menstruating

Sudden cramping or pelvic pain could be signs of infection. An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility.

If there are the following symptoms of an infection, seek prompt medical attention:

• Fever
• Foul-smelling vaginal discharge
• Severe pelvic pain
• Sudden pain, especially if the woman may be pregnant

RISK FACTORS

One might be at risk of menstrual cramps if:

• She is younger than age 30
• She bleeds heavily during periods (menorrhagia)
• She has a family history of menstrual cramps (dysmenorrhea)
• She started puberty early, at age 11 or younger
• She has irregular menstrual bleeding (metrorrhagia)
• She is a smoker

COMPLICATIONS

Menstrual cramps do not cause other medical complications, but they can interfere with daily life activities at school, work and social activities.

Certain conditions associated with menstrual cramps can have complications, though. For example pelvic inflammatory disease can scar one's fallopian tubes, increasing the risk of a fertilized egg implanting outside of the uterus (ectopic pregnancy).

DIAGNOSIS

The doctor will review medical history and perform a physical exam, including a pelvic exam. The doctor will check for abnormalities in the reproductive organs and look for signs of infection during the pelvic exam.

Should the doctor suspect that a disorder is causing the menstrual cramps, he or she may recommend other tests, such as:

• Ultrasound - This test uses sound waves to create an image of the uterus, cervix, fallopian tubes and ovaries.
• Other imaging tests - A CT scan or MRI scan provides more detail than an ultrasound which can help the doctor diagnose underlying conditions. CT combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside the body. While MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures.
• Laparoscopy - Laparoscopy can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, the doctor views the abdominal cavity and reproductive organs by making tiny incisions in the abdomen and inserting a fiber-optic tube with a small camera lens.

TREATMENT

If treatment at home does not relieve the menstrual pain, medical treatment options exist.

Type of treatment will depend on how severe and the underlying cause of the pain. If the pain is being caused by PID or sexually transmitted infections (STIs), the doctor will prescribe antibiotics to clear the infection.

The doctor may also prescribe medications that include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - These drugs can be found over the counter or get the strong one under prescription from the doctor.
• Other pain relievers - This includes over-the-counter options like Tylenol or stronger prescription pain medications.
• Antidepressants : Sometimes, antidepressants are prescribed to help lessen some of the mood swings that are associated with PMS.

Doctors may also suggest hormonal birth control. Hormonal birth control is available as a pill, patch, vaginal ring, injection, implant, or IUD. Hormones prevent ovulation, which can control the menstrual cramps.

If other treatments have not been successful, surgery can treat endometriosis or uterine fibroids. The surgery removes any endometriosis implants, uterine fibroids, or cysts.

In rare cases, another available option if other treatments haven't worked and the pain is severe is the surgical removal of the uterus (hysterectomy). The problem however is that after a hysterectomy the patient will no longer be able to have children. This option therefore, is usually only used if someone is not planning to have children or is at the end of their childbearing years.

HOME TREATMENT

At-home treatments can be helpful in relieving painful menstrual periods. Some of the things to try at home include:

The use of a heating pad on the pelvic area

The massage of the abdomen

The taking of warm baths

Exercising regularly

Eating light, nutritious meals

Practicing relaxation techniques or perhaps yoga

Taking anti-inflammatory medications such as ibuprofen days before the period

Taking vitamins and supplements such as:

• Omega-3 fatty acids
• Magnesium
• Vitamin B-6
• Vitamin B-1
• Vitamin E
• Calcium

Raising the legs or lying with knees bent

Reducing the intake of salt, alcohol, caffeine, and sugar to prevent bloating

ALTERNATIVE MEDICINE

Most alternative therapies for treating menstrual cramps have not been studied deep enough for experts' recommendation. However, some alternative treatments might help, including:

Acupuncture - Acupuncture involves inserting extremely thin needles through the skin at strategic points on the body. Some studies have established that acupuncture helps relieve menstrual cramps.

Transcutaneous electrical nerve stimulation (TENS) : This is a device that connects to the skin by way of adhesive patches that have electrodes in them. The electrodes deliver a varying level of electric current to stimulate nerves. 'TENS' might work by raising the threshold for pain signals and stimulating the release of your body's natural painkillers (endorphins).

Herbal medicine - Some herbal products, such as Milyash herbs' combination of Femitol, (if level of estrogen is low), Anvite and Laminarin can provide some relief from menstrual cramps.

Acupressure - Like acupuncture, acupressure also involves stimulating certain points on the body, but with gentle pressure on the skin instead of needles. Studies on acupressure and menstrual cramps is limited. It appears however, that acupressure may be more effective than a placebo in easing menstrual cramps.

THE BOTTOM LINE

Digestion problems often represents an embarrassment, and so many people understandably try to hide their issues. It is important to know, however, that no one is alone.

In fact, many disease control sources estimate that digestive disease complaints comprise a huge chunk of emergency room visits annually.

Changing the diet and exercising habits are often the first recommended steps to better digestive health. If you still continue to experience digestion problems, it most definitely time to see a doctor.