What Is Dysmenorrhea?

Having mild pain during periods (menstruation) is common among many girls and women. If you experience an unbearable pain, which is not relieved by pain medication, then you may have Dysmenorrhea, the medical term for difficult/painful periods. Dysmenorrhea is different from pre menstrual syndrome (PMS). PMS starts few days before periods and eases when your periods start. Whereas, in dysmenorrhea, the pain is worse during first few days of periods.

During menstruation, blood supply to uterus  lining (endometrium) is reduced. This leads to uterus contractions, a condition where uterus tightens and relaxes and thus blood is let out of uterus. During this process, endometrium releases Prostaglandins, which increase the strength of contractions and as a result, you experience cramp like pain. High levels of prostaglandins may sometimes cause other discomforts such as nausea, diarrhea, and/or lightheadedness.

Types Of Dysmenorrhea

There are two types of dysmenorrhea:

Primary Dysmenorrhea:

  • More than 50% of women suffer from primary dysmenorrhea, an ordinary menstrual pain that has no underlying gynecologic disorder.
  • In most cases, the pain eases after pregnancy.
  • Around 15% suffer with sever pain.Though painful, primary dysmenorrhea is not harmful.

Secondary Dysmenorrhea:

  • When a gynecologic condition, such as fibroid or endometriosis causes lower abdominal cramps, it is known as secondary dysmenorrhea.
  • Most cases are easily treated with medications, however some may need more invasive solutions such as surgery.
  • Generally young girls are not affected by secondary dysmenorrhea; Women, during adulthood, are more susceptible.

Signs And Symptoms

Primary Dysmenorrhea:

  • Onset: within 6 months of your first menstruation.
  • Cramps/lower abdominal pain, starting 1-2 days prior to menstruation. Pain may last as long as 4 days.
  • The pain may radiate to your back or thigh
  • Often associated with unremarkable findings after a routine pelvic or rectal examination

Secondary Dysmenorrhea:

  • Onset: when women are in their 20s or 30s
  • Heavy and/or irregular menstrual flow
  • Pelvic abnormality
  • Poor response to Non Steroidal Anti Inflammatory Drugs (NSAID)
  • Poor response to Oral Contraceptives
  • Infertility
  • Dyspareunia, painful sexual intercourse caused by medical or psychological conditions
  • Vaginal discharge

Causes Of Dysmenorrhea?

Primary Dysmenorrhea:

  • Primary Cause: Excessive levels of prostaglandins
  • Other influencing factors:
    • Retroverted uterus, a condition where the uterus tilts backward instead of forward
    • Lack of exercise and/or being overweight
    • Stress (psychological or social)
    • Lifestyle habits such as smoking and drinking alcohol
    • Start menstruating before 11 years of age

Secondary Dysmenorrhea:

Conditions that may cause secondary dysmenorrhea are:

  • Endometriosis: Uterus lining (endometrium) implants/grows in fallopian tubes/ovaries/pelvis instead of uterus
  • Fibroids: Benign tumors found within the uterine wall
  • Adenomyosis: Uterus lining (endometrium) implants/grows within muscular walls of uterus
  • Being infected by a Sexually Transmitted Infection (STI)
  • Pelvic Inflammatory Disease(PID): Affects mainly the fallopian tubes, but can also affect other parts such as ovaries, uterus, and cervix.
  • Cervical Stenosis: Narrowing cervix, which may hinder blood flow out of uterus.
  • An ovarian cyst/tumour
  • Using an Intra Uterine Device (IUD).

Tests And Diagnosis

After reviewing your medical history, your doctor will perform physical examination. If your doctor suspects an underlying disorder, further tests may be prescribed, such as:

  • Ultrasound (a test using sound waves to create an image) of cervix, uterus, fallopian tubes, and ovaries.
  • CT Scan ( a test that uses x-rays taken from multiple anges to create a cross-sectional image)
  • Magnetic Resonance Imaging(MRI) (a test that uses magnetic field and radio waves to create images)
  • Laparoscopy (an outpatient surgery, where tiny incisions are made, small camera lens with a fiber-optic tube is inserted, and organs are viewed).

Treatments And Drugs

Your doctor may prescribe:

  • Pain relievers – Over the counter pain relievers and Non Steroidal Anti Inflammatory Drugs (NSAIDS)
  • Hormonal birth control (injection/patch/implat/ring/IUD) - They prevent ovulation and ease menstrual cramps.
  • Surgery – That can cure an underlying disorder or remove uterus

Non-medicinal Treatments

To ease the pain of dysmenorrhea, try to:

  • Lie down on your back, support knees with pillow
  • Use a heating pad/hot water bottle on abdomen/lower back
  • Take warm bath
  • Gently massage abdomen
  • Exercise mildly to increase blood flow and reduce pain
  • Rest and avoid stress around your periods
  • Do yoga



The above article serves only as reference. Kindly refer to your primary care provider for complete consultation and treatment.

For more details please send email to: generalenquiry@shanghaiskyclinic.com


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