Dysmenorrhea, also known as painful periods or menstrual cramps, is pain during menstruation. Its usual onset occurs around the time that menstruation begins. Symptoms typically last less than three days. The pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea or nausea.
Estimates of the percentage of women of reproductive age affected vary from 20% to 90%. It is the most common menstrual disorder. Typically, it starts within a year of the first menstrual period. When there is no underlying cause, often the pain improves with age or following having a child.
Signs and symptoms
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen or pelvis. It is also commonly felt in the right or left side of the abdomen. It may radiate to the thighs and lower back.
Symptoms often co-occurring with menstrual pain include nausea and vomiting, diarrhea, headache, dizziness, disorientation, fainting and fatigue. Symptoms of dysmenorrhea often begin immediately after ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. In particular, prostaglandins induce abdominal contractions that can cause pain and gastrointestinal symptoms. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea because they stop ovulation from occurring.
Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Primary dysmenorrhea occurs without an associated underlying condition, while secondary dysmenorrhea has a specific underlying cause, typically a condition that affects the uterus or other reproductive organs.
During an individual's menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus shed.
Prostaglandins and leukotrienes are released during menstruation, due to the build up of omega-6 fatty acids. Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract and can result in systemic symptoms such as nausea, vomiting, bloating and headaches or migraines. Prostaglandins are thought to be a major factor in primary dysmenorrhea. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are thought to be responsible for the pain or cramps experienced during menstruation.
Compared with non-dysmnenorrhic individuals, those with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.
The diagnosis of dysmenorrhea is usually made simply on a medical history of menstrual pain that interferes with daily activities. However, there is no universally accepted standard technique for quantifying the severity of menstrual pains. There are various quantification models, called menstrual symptometrics, that can be used to estimate the severity of menstrual pains as well as correlate them with pain in other parts of the body, menstrual bleeding and degree of interference with daily activities.
Once a diagnosis of dysmenorrhea is made, further workup is required to search for any secondary underlying cause of it, in order to be able to treat it specifically and to avoid the aggravation of a perhaps serious underlying cause.
Further work-up includes a specific medical history of symptoms and menstrual cycles and a pelvic examination. Based on results from these, additional exams and tests may be motivated, such as:
Use of hormonal birth control may improve symptoms of primary dysmenorrhea. A 2009 systematic review found limited evidence that the low or medium doses of estrogen contained in the birth control pill reduces pain associated with dysmenorrhea. In addition, no differences between different birth control pill preparations were found.
A 2016 Cochrane review of acupuncture for dysmenorrhea concluded that it is unknown if acupuncture or acupressure is effective. There were also concerns of bias in study design and in publication, insufficient reporting (few looked at adverse effects), and that they were inconsistent. There are conflicting reports in the literature, including one review which found that acupressure, topical heat, and behavioral interventions are likely effective. It found the effect of acupuncture and magnets to be unknown.
A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.
Spinal manipulation does not appear to be helpful. Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms, a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.
Dysmenorrhea is one of the most common gynecological problems, regardless of age or race. It is one of the most frequently identified etiology of pelvic pain in menstruating adults. The prevalence of dysmenorrhea can vary between 16% and 91% of surveyed individuals, with severe pain observed in 2% to 29% of menstruating individuals. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. The prevalence in adolescent females has been reported to be 67.2% by one study and 90% by another. It has been stated that there is no significant difference in prevalence or incidence between races, although one study of Hispanic adolescent females indicated an elevated prevalence and impact in this group. Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity.Childbearing is said to relieve dysmenorrhea, but this does not always occur. One study indicated that in nulliparous individuals with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40.
A survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work. Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence.
^ abGomathy N, Dhanasekar KR, Trayambak D, Amirtha R (2019). "Supportive therapy for dysmenorrhea: Time to look beyond mefenamic acid in primary care". J Family Med Prim Care. 8 (11): 3487-3491. PMID31803641.CS1 maint: uses authors parameter (link)
^Laura A Payne, Andrea J Rapkin, Laura C Seidman, Lonnie K Zeltzer, and Jennie CI Tsao (2017). "Experimental and procedural pain responses in primary dysmenorrhea: a systematic review". J Pain Res. 10: 2233-2246. PMID29066929.CS1 maint: uses authors parameter (link)
^"Period Pain". MedlinePlus. National Library of Medicine. March 1, 2018. Retrieved 2018.
^Hilário SG, Bozzini N, Borsari R, Baracat EC (January 2009). "Action of aromatase inhibitor for treatment of uterine leiomyoma in perimenopausal patients". Fertility and Sterility. 91 (1): 240-3. doi:10.1016/j.fertnstert.2007.11.006. PMID18249392.
^Nabeshima H, Murakami T, Nishimoto M, Sugawara N, Sato N (2008). "Successful total laparoscopic cystic adenomyomectomy after unsuccessful open surgery using transtrocar ultrasonographic guiding". Journal of Minimally Invasive Gynecology. 15 (2): 227-30. doi:10.1016/j.jmig.2007.10.007. PMID18312998.
^Hacker, Neville F., J. George Moore, and Joseph C. Gambone. Essentials of Obstetrics and Gynecology, 4th ed. Elsevier Saunders, 2004. ISBN0-7216-0179-0[page needed]
^Acién P, Acién M, Fernández F, José Mayol M, Aranda I (November 2010). "The cavitated accessory uterine mass: a Müllerian anomaly in women with an otherwise normal uterus". Obstetrics and Gynecology. 116 (5): 1101-9. doi:10.1097/AOG.0b013e3181f7e735. PMID20966695.
^Ju H, Jones M, Mishra G (2014). "The prevalence and risk factors of dysmenorrhea". Epidemiol Rev. PMID24284871.
^Nagulapalli Venkata KC, Swaroop A, Bagchi D, Bishayee A (2017). "A small plant with big benefits: Fenugreek (Trigonella foenum-graecum Linn.) for disease prevention and health promotion". Mol Nutr Food Res. 61 (6): 1600950. doi:10.1002/mnfr.201600950. PMID28266134.
^Zhu X, Proctor M, Bensoussan A, Wu E, Smith CA (April 2008). Zhu X (ed.). "Chinese herbal medicine for primary dysmenorrhoea". The Cochrane Database of Systematic Reviews (2): CD005288. doi:10.1002/14651858.CD005288.pub3. PMID18425916.
^Gao L, Jia C, Zhang H, Ma C (October 2017). "Wenjing decoction (herbal medicine) for the treatment of primary dysmenorrhea: a systematic review and meta-analysis". Archives of Gynecology and Obstetrics. 296 (4): 679-689. doi:10.1007/s00404-017-4485-7. PMID28791471.
^Sharma P, Malhotra C, Taneja DK, Saha R (February 2008). "Problems related to menstruation amongst adolescent girls". Indian Journal of Pediatrics. 75 (2): 125-9. doi:10.1007/s12098-008-0018-5. PMID18334791.
^Juang CM, Yen MS, Horng HC, Cheng CY, Yuan CC, Chang CM (October 2006). "Natural progression of menstrual pain in nulliparous women at reproductive age: an observational study". Journal of the Chinese Medical Association. 69 (10): 484-8. doi:10.1016/S1726-4901(09)70313-2. PMID17098673.