Dysmenorrhea (patient information)

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Painful menstrual periods during which a woman experiences either a crampy lower abdominal pain, sharp pain that comes and goes, aching pain, or possibly back pain.

• Painful menstruation affects many women.

• For a small number of women, the discomfort makes it difficult to perform normal household, job, or school-related activities for a few days during each menstrual cycle.
• Painful menstruation is the leading cause of lost time from school and work among women in their teens and 20s.

• The pain may begin several days before, or just at the start of your period. It generally lessens as menstrual bleeding tapers off.

• Although some pain during menstruation is normal, excessive pain is not. The medical term for excessively painful periods is dysmenorrhea.

• Primary dysmenorrhea refers to menstrual pain that occurs around the time that menstrual periods first begin in otherwise healthy young women.

• This type of pain is usually not related to any specific problems with the uterus or other pelvic organs.
• Increased activity of the hormone prostaglandin, which is produced in the uterus, is thought to be a factor in primary dysmenorrhea.

• Secondary dysmenorrhea is menstrual pain that develops later, after periods have been more normal, and is often related to problems in the uterus or other pelvic organs, such as:

• Endometriosis
• Fibroids
• Intrauterine device (IUD) made of copper
• Ovarian cysts
• Pelvic inflammatory disease
• Premenstrual syndrome (PMS)
• Sexually transmitted diseases
• Stress and anxiety

• Call your doctor right away if:

• Vaginal discharge is increased in amount or is foul-smelling.
• You have a fever.
• Your pain is significant, your period is more than one week late, and you have been sexually active.

• Also call your doctor if:

• Self-care measures don’t relieve your pain after 3 months.
• You have an IUD that was placed more than 3 months ago.
• You pass blood clots or have other symptoms with the pain.
• Your pain is severe or sudden.
• Your pain occurs at times other than menstruation, begins more than 5 days before your period, or continues after your period is over.

• Your doctor will examine you, paying close attention to your pelvis and abdomen, and ask questions about your medical history and current symptoms, such as:

• How old were you when your periods started?
• Have they always been painful? If not, when did the pain begin?
• When in your menstrual cycle do you experience the pain?
• Is the pain sharp, dull, intermittent, constant, aching, or cramping?
• Are you sexually active?
• Do you use birth control? What type?
• When was your last menstrual period?
• Was the flow of your last menstrual period a normal amount for you?
• Do your periods tend to be heavy or prolonged (lasting longer than 5 days)?
• Have you passed blood clots?
• Are your periods generally regular and predictable?
• Do you use tampons with menstruation?
• What have you done to try to relieve the discomfort? How effective was it?
• Does anything make the pain worse?
• Do you have any other symptoms?

• Diagnostic tests that may be performed include:

• Blood tests including CBC
• Cultures (may be taken to rule out sexually transmitted diseases such as gonorrhea, primary syphilis, or chlamydia infections)
• Laparoscopy
• Ultrasound

• Your health care provider may prescribe birth control pills to relieve menstrual pain. If you don’t need them for birth control, you can stop using the pills after 6 to 12 months. Many women continue to have symptom relief even after stopping the medication.

• Surgery may be necessary for women who are unable to get enough pain relief or pain control. Procedures may range from removal of cysts, polyps, adhesions, endometriosis, or fibroids to a complete hysterectomy.

• Prescription medications may be used for endometriosis.

• For pain caused by an IUD, your doctor may recommend:

• Waiting until the end of the first year of use. Painful periods go away in many women during this time.
• Have the IUD removed and use alternative birth control methods.
• Change to an IUD that contains progesterone, which usually makes the periods lighter and less painful.

• The following steps may allow you to avoid prescription medications:

• Apply a heating pad to your lower abdomen (below your belly button). Be careful NOT to fall asleep with the heating pad on.
• Do light circular massage with your fingertips around your lower abdomen.
• Drink warm beverages.
• Eat light but frequent meals.
• Follow a diet rich in complex carbohydrates such as whole grains, fruits, and vegetables, but low in salt, sugar, alcohol, and caffeine.
• Keep your legs elevated while lying down, or lie on your side with your knees bent.
• Practice relaxation techniques such as meditation or yoga.
• Try over-the-counter anti-inflammatory medicine, such as ibuprofen. Start taking it the day before your period is expected to start, and continue taking it regularly for the first few days of your period.
• Try vitamin B6, calcium, and magnesium supplements, especially if your pain is from PMS.
• Take warm showers or baths.
• Walk or exercise regularly, including pelvic rocking exercises.
• Lose weight if you are overweight.

• If these self-care measures do not work, your doctor may prescribe medications such as:

• Antibiotics
• Antidepressants
• Birth control pills
• Prescription anti-inflammatory medicines such as meclofenamate (Meclomen)
• Prescription pain relievers (including narcotics such as codeine, for brief periods)

Directions to Hospitals Treating Dysmenorrhea

http://www.nlm.nih.gov/medlineplus/ency/article/003150.htm

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