Dysmenorrhea-More Commonly Known as Painful Periods

Dysmenorrhea is the term used to describe painful menstrual periods, and while primary dysmenorrhea has no underlying cause, secondary dysmenorrhea does generally have an underlying gynecological disorder. Primary dysmenorrhea can affect up to 50 percent of all women who have menstrual periods, and up to 15% of these women will have a level of pain that interferes with their daily lives. Typically, dysmenorrhea begins during adolescence, although occasionally it can begin later in a woman's life. The prevalence of dysmenorrhea is estimated to be up to 90% in adolescents, and, in fact, is the most common reason for school absence. Dysmenorrhea can be crippling, both physically and psychologically.

How Dysmenorrhea Begins

As women, we are all aware that each month the lining of the uterus thickens-should the woman not become pregnant during that cycle, the majority of the endometrium is shed, and menstrual bleeding occurs, flowing from the uterus, through the cervical canal, and out the vagina. Primary dysmenorrhea occurs when the uterus contracts because the blood supply to the endometrium is reduced, and should the cervical canal be particularly narrow, the pain can be even worse as the endometrial tissue passes through the cervix. A tipped uterus can also cause excess pain, as can low levels of physical activity and emotional stress. When the uterine tissue grows outside the uterus, endometriosis occurs, and secondary dysmenorrhea is the result.

Symptoms of dysmenorrhea

A woman with dysmenorrhea will typically experience severe cramps in the lower abdomen, usually shortly before her period begins; the pain may either be continuous, or can come and go. In some cases, women report the pain from dysmenorrhea extends into their lower back and legs, and in many causes the severe pain is accompanied by headaches, nausea, diarrhea, constipation, or the need to urinate frequently. In the most severe cases of dysmenorrhea, vomiting occurs, making participation in the everyday activities of life, nearly impossible. The most severe dysmenorrhea symptoms generally occur approximately 24 hours after they begin, and begin to subside after two or three days.

Risk Factors for Dysmenorrhea

Some of the risk factors for primary dysmenorrhea include an early onset of menstrual periods (before the age of 12), heavy or prolonged menstrual flow, a prior family history of dysmenorrhea, obesity, or a history of smoking. The risk factors for secondary dysmenorrhea include the presence of fibroid tumors, pelvic inflammatory disease, tubo-ovarian abscesses, endometriosis, IUD, or ovarian torsion.

How is Dysmenorrhea Diagnoses?

If you have symptoms of dysmenorrhea, your doctor will need to take a complete medical history and perform a pelvic exam. He will likely ask you about the specifics of your lifestyle, sexual activity and medications you are taking, and will feel for fibroid tumors during your pelvic. Your doctor will look for abnormalities in your uterine tissue by removing a sample from the inside of the uterus, then sending it for biopsy. Endometriosis can be diagnosed through biopsy and laparoscopy in which the doctor makes a small cut in your navel, inserts a small instrument called a laparoscope, and essentially "looks around" your uterus, fallopian tubes and other female organs.

Types of Treatment for Dysmenorrhea

The treatment for your dysmenorrhea will depend on your doctor's determination of the underlying cause. He will probably prescribe non-prescription anti-inflammatory drugs such as Tylenol, Aleve, or Advil, and recommend that you begin taking the medications up to two days before your period begins, continuing to take them for a couple of days into your period. Self-care can include getting plenty of rest, particularly during your menstrual period, eating a healthy diet, and getting exercise during your period. While it may seem especially difficult to get out and exercise when you are feeling such pain, physical exercise can relieve much of the pain from dysmenorrhea. Some women with pain so severe from their primary dysmenorrhea that it interferes with their daily lives will benefit from a low-dose birth control pill, while those with secondary dysmenorrhea will need to treat the cause through hormone therapy or surgical removal of fibroids. If the fibroids are extremely large, you may need to undergo a hysterectomy.

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