Dysmenorrhea is the occurrence of painful cramps during menstruation.
More than half of all girls and women suffer from dysmenorrhea (cramps), a dull or throbbing pain that usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps.
While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month. In fact, about 43 % of women in the United States suffer pain so severe that it disrupts their daily lives and about 18% miss one or more days or work, school, or other activities each year because of menstrual cramps.
Causes & symptoms
Dysmenorrhea is called "primary" when there is no specific abnormality, and "secondary" when the pain is caused by an underlying gynecological problem. It is believed that primary dysmenorrhea occurs when prostaglandins, hormone-like substances produced by uterine tissue, trigger strong muscle contractions in the uterus during menstruation. However, the level of prostaglandins does not seem to correlate with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts assume that cramps must also be related to other causes, such as diets, genetics, stress, and different body types, in addition to prostaglandins. The first year or two of a girl's periods are not usually very painful. However, once ovulation begins, the blood levels of the prostaglandins rise, leading to stronger contractions.
Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the pelvis.
The likelihood that a woman will have cramps increases if she:
- has a family history of painful periods
- leads a stressful life
- doesn't get enough exercise
- uses caffeine
- has pelvic inflammatory disease (PID)
Symptoms include a dull, throbbing cramping in the lower abdomen that may radiate to the lower back and thighs. In addition, some women may experience nausea and vomiting, diarrhea, irritability, sweating, or dizziness. Cramps usually last for two or three days at the beginning of each menstrual period. Many women often notice their painful periods disappear after they have their first child, probably due to the stretching of the opening of the uterus or because the birth improves the uterine blood supply and muscle activity, although others do not notice a change.
A doctor should perform a thorough pelvic exam and take a patient history to rule out any underlying condition that could cause cramps.
The following dietary changes may help prevent or treat menstrual pain:
- Increased dietary intake of foods such as fiber, calcium, soy foods, fruits and vegetables.
- Decreased consumption of foods that exacerbate PMS. They include caffeine, salt and sugar.
- Quitting smoking. Smoking has been found to worsen cramps.
- Taking daily multi-vitamin and mineral supplements that contain high doses of magnesium and vitamin B6 (pyridoxine), and flaxseed or fish oil supplements. Recent research suggests that vitamin B supplements, primarily vitamin B6 in complex, magnesium, calcium, zinc, vitamin E, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.
An herbalist may recommend one of the following herbal remedies for menstrual pain:
- Chasteberry (Vitex agnus-castus) for women who also experience breast pain, irregular periods, and ovarian cysts.
- Dong quai (Angelica sinensis) for women with typical menstrual pain.
- Licorice (Glycyrrhiza glabra) for abdominal bloating and cramping.
- Black cohosh (Cimifuga racemosa) for relief of menstrual pain as well as mood swing and depression.
Several yoga positions are popular as methods to ease menstrual pain. In the "cat stretch" position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and buttocks.
Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers.
Acupuncture and Chinese herbs are other popular alternative treatments for cramps. There are particular formulas depending on the pattern of imbalance. Aromatherapy and massage may ease pain for some women. Transcutaneous Electrical Nerve Stimulation (TENS) has been touted as a safe and practical way to relieve the pain of dysmenorrhea. It works by using electrodes to stimulate nerve fibers. Some women find relief through visualization, concentrating on the pain as a particular color and gaining control of the sensations. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods. Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position with knee pulled up to the chest while hugging a heating pad or pillow to the abdomen. Also, orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.
Several drugs can lessen or completely eliminate the pain of primary dysmenorrhea. Most popular are the non-steroidal anti-inflammatory drugs (NSAIDs), which prevent or decrease the formation of prostaglandins. These include aspirin, ibuprofen (Advil), and naproxen (Aleve). For more severe pain, prescription strength ibuprofen (Motrin) is available. These drugs are usually begun at the first sign of the period and taken for a day or two.
If an NSAID is not available, acetaminophen (Tylenol) may also help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help.
Studies of a drug patch containing glyceryl trinitrate to treat dysmenorrhea suggest that it also may help ease pain. This drug has been used in the past to ease preterm contractions in pregnant women.
In 2002, an intrauterine device (IUD) was introduced to help eliminate the pain of menstrual cramps related to endometriosis. The IUD, known as Mirena, is approved for use in the Untied States as a contraceptive.
Treatments should lessen or eliminate pain.
Avoidance of caffeine, alcohol, and sugar prior to onset of period and NSAIDs taken a day before the period begins should eliminate cramps for some women.
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American College of Obstetricians and Gynecologists. 409 12th St. SW, Washington, DC 20024. (202) 638-5577.
Federation of Feminist Women's Health Centers. 633 East 11th Ave., Eugene, OR 97401. (503) 344-0966.
National Women's Health Network. 1325 G St. NW, Washington, DC 20005. (202) 347-1140.
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