Questions About Dysmenorrhea

1. What is Dysmenorrhea?

Dysmenorrhea is the term used to describe very painful menstrual periods. Most people with periods experience some level of discomfort before and/or during their period. For some people, this pain and discomfort is beyond what is considered “normal”, to the point where it can be debilitating. This condition is more common than you might think and can affect up to 90% of women at some point in their reproductive years. Of this, up to 29% have particularly severe dysmenorrhea.

2. What Are The Types of Dysmenorrhea?

Dysmenorrhea, or menstrual pain, can be classified into two primary types: primary and secondary dysmenorrhea.

Primary Dysmenorrhea

Primary dysmenorrhea is characterized by pain during menstruation that isn't due to any identifiable medical condition. The discomfort usually begins a few days before the onset of a period and can continue into the first few days of menstruation. This type of dysmenorrhea is believed to result from increased levels of prostaglandins—hormone-like substances that induce uterine muscle contractions to help shed the uterine lining during a menstrual period. While these contractions are a normal part of the menstrual process, elevated levels of prostaglandins can lead to more intense contractions and pain.

Secondary Dysmenorrhea

Secondary dysmenorrhea, on the other hand, is menstrual pain that stems from reproductive system disorders. It is associated with various medical conditions, including:

• Endometriosis:
  A condition where tissue similar to the lining of the uterus begins to grow in other locations, such as the exterior of the uterus, the ovaries, or even on the bladder or intestines. This ectopic tissue can cause significant inflammation and pain, and it may also affect fertility.
• Uterine Fibroids:
  These noncancerous growths appear in or on the uterine walls. Fibroids are usually benign but can cause discomfort or pain if they grow large enough.
• Pelvic Inflammatory Disease (PID):
  An infection that affects the uterus, ovaries, and fallopian tubes, typically resulting from untreated sexually transmitted infections. PID can start as a vaginal infection and then spread, leading to serious and painful inflammation of the reproductive organs.

3. What Are The Symptoms of Dysmenorrhea?

The primary symptom of dysmenorrhea is intense pelvic pain, commonly referred to as "period cramps." In addition to this central symptom, some individuals may experience a range of other discomforts, including:

• Persistent pain in the pelvic region not limited to menstrual periods
• Gastrointestinal upset, such as diarrhea, nausea, and bloating
• Headaches
• Pain in the lower back
• Mood disturbances, particularly irritability
• General fatigue

The specific symptoms and their intensity can vary widely among individuals and may differ based on whether the dysmenorrhea is primary or secondary.

4. What Diagnostic Tests Are There for Dysmenorrhea?

The diagnostic process for dysmenorrhea is contingent upon distinguishing between primary and secondary forms. Secondary dysmenorrhea is diagnosed when a healthcare professional identifies a specific medical condition causing the pain. Conversely, primary dysmenorrhea is diagnosed based on symptomatology when no distinct medical cause is detectable.

Tests used in diagnosis include a detailed description of symptoms, a physical exam, blood tests, and even possibly imaging such as ultrasounds of the pelvic area. There are even certain exploratory surgeries that can be performed to better visualize the organs and make definitive diagnoses. This way a healthcare provider can help form a diagnosis and rule out other causes such as sexually transmitted infections and pregnancy.

5. What Treatment Options Are There for Dysmenorrhea?

The management of dysmenorrhea typically involves a consistent approach for both primary and secondary types, aimed at mitigating pain rather than providing a cure. The following are common treatment strategies:

Despite these challenges, many people with endometriosis do achieve pregnancy, some without intervention, while others may require medical assistance through fertility treatments. It is important for those diagnosed with endometriosis to discuss their reproductive goals with their healthcare provider, as it may influence treatment options and strategies.

• Non-steroidal Anti-inflammatory Drugs (NSAIDs):
  Medications such as ibuprofen (Advil) and naproxen can be highly effective. They serve a dual purpose: alleviating pain and reducing inflammation, which is often the source of menstrual discomfort.
• Hormonal Birth Control:
  • Hormonal contraceptives, including pills, patches, or intrauterine devices (IUDs), are frequently utilized to lessen dysmenorrhea-related pain. They are suitable for those not trying to conceive and can reduce menstrual pain by thinning the uterine lining. A thinner lining produces fewer prostaglandins during shedding, thereby decreasing pain.
  • Continuous dosing, or using hormone-based birth control without the standard week-long break, can help reduce the frequency of periods and associated pain. An IUD provides a continuous release of hormones, which may lead to lighter periods or their complete cessation for some users.
• Non-pharmacological Methods:
  Applying heat with a heating pad or hot water bottle to the lower abdomen can relax muscles and ease pain, but caution should be exercised to avoid burns. Light physical activity, such as walking or practicing yoga, can also provide symptomatic relief by enhancing blood flow and reducing muscle tension.

There are sometimes additional treatment options for those with secondary dysmenorrhea. Depending on the specific cause there are sometimes procedures available to remove any extra tissue or decrease blood flow to the uterus. In extreme cases, some individuals will even elect for a hysterectomy (uterus removal) in order to remove the issue altogether. Of course, this is a serious procedure that comes with risks such as infection and induced menopause, though it is an option when the pain prevents you from going about your life.