Dysmenorrhea refers to the cramping pain in the lower abdomen associated with menstruation. It is one of the commonest complaints among young ladies and it can range from mild to severe. In fact, it can be severe enough to warrant a sick-off and presentation to the emergency room. Severe forms can also result in vomiting, diarrhea, headache and fainting.
The process of menstruation is modulated by several chemical substances in the body, chiefly the “prostaglandins”. These prostaglandins are responsible for contractions of uterine vessels resulting in pain. Any abnormal increase in the amount, or activity of these prostaglandins result in proportional increase in the severity of the pain. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea usually starts early (soon after a girl starts to menstruate) and there is no identifiable cause. But secondary dysmenorrhea starts much later (>5years after the onset of menses) and it’s usually due to an underlying cause.
Causes of secondary dysmenorrhea include:
*Endometriosis : presence of the lining of the womb in other sites within the abdomen, causing internal cyclic bleeding and pain.
*Pelvic inflammatory disease: ascending infection of the genital tract.
*Ovarian pathology: eg. Cysts
*Uterine pathology: eg. Fibroids
*Cervical pathology: eg. Stenosis- abnormal tightening of the cervix
*Uterine adhesions: due to previous surgery(ies) or repeated D&C
*Malformations of the genital tract
Risk factors for dysmenorrhea include:
*Family history of dysmenorrhea
*Early age at menstrual debut (11 or less)
*Infertility or Nulliparity
*Other menstrual problems, eg. Heavy bleeding.
How can you rule out a secondary cause?
*See a doctor for a thorough medical history and examination
*You may need to undergo some laboratory, radiological and diagnostic procedures (like laparoscopy)
What are the modes of treatment?
*It depends on whether it is primary or secondary. Treatment of secondary dysmenorrhea is that of the underlying cause. This can be medical or surgical.
*It also depends on your fertility status. If you’re single or married but not ready to conceive any time soon, hormonal contraceptives can be used.
*Management is mainly based on pain relief. Non-steroidal anti-inflammatory drugs (NSAID’s) are the mainstay of treatment. Examples are piroxicam and diclofenac. Paracetamol can also be used for mild pain. Severe pain can require stronger analgesics like morphine.
*NSAID’s should be used with caution in peptic ulcer, liver and kidney disease patients. See your doctor/pharmacist for advice and correct dosage.
*Hormonal contraceptives are also effective in the treatment of dysmenorrhea. They come in form of pills, injections, implants and intrauterine devices. The mechanism is to prevent ovulation, and in some cases menstruation, creating a pseudo-pregnancy or menopausal state.
*A more natural alternative to contraception is to get married and pregnant as the hormones of pregnancy and lactation totally block menstruation and relieve dysmenorrhea even after delivery. However, this cannot be guaranteed 100%, especially if there is a secondary underlying cause.
*Several non-orthodox treatments have been described with little or no scientific evidence. Acupuncture, yoga, herbal products, pure honey, massage, warm drinks and warm baths or gentle compressions with a hot water bottle can help too.
Can dysmenorrhea be prevented? Yes (to some extent)
*Maintain a healthy weight (BMI 18-25)
*Eat a low-fat, vegetarian diet.
*Stop drinking alcohol.
*Try some dietary supplements like vitamin B6 and E.