- Original Article | https://my.clevelandclinic.org/health/diseases/4148-dysmenorrhea
- Date Published | May 29, 2018
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- Health Library | Disease & Conditions | Dysmenorrhea
What is dysmenorrhea?
Dysmenorrhea is the medical term for pain with menstruation. There are two types of dysmenorrhea: "primary" and "secondary".
Primary dysmenorrhea is common menstrual cramps that are recurrent (come back) and are not due to other diseases. Pain usually begins 1 or 2 days before, or when menstrual bleeding starts, and is felt in the lower abdomen, back, or thighs. Pain can range from mild to severe, can typically last 12 to 72 hours, and can be accompanied by nausea-and-vomiting, fatigue, and even diarrhea. Common menstrual cramps usually become less painful as a woman ages and may stop entirely if the woman has a baby.
Secondary dysmenorrhea is pain that is caused by a disorder in the woman's reproductive organs, such as endometriosis, adenomyosis, uterine fibroids, or infection. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The pain is not typically accompanied by nausea, vomiting, fatigue, or diarrhea.
What causes dysmenorrhea (pain of menstrual cramps)?
Menstrual cramps are caused by contractions (tightening) in the uterus (which is a muscle) by a chemical called prostaglandin. The uterus, where a baby grows, contracts throughout a woman's menstrual cycle. During menstruation, the uterus contracts more strongly. If the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus. Pain results when part of the muscle briefly loses its supply of oxygen.
How does secondary dysmenorrhea cause menstrual cramps?
Menstrual pain from secondary dysmenorrhea is caused by a disease in the woman's reproductive organs. Conditions that can cause secondary dysmenorrhea include:
- Endometriosis - A condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus.
- Adenomyosis – A condition where the lining of the uterus grows into the muscle of the uterus.
- Pelvic inflammatory disease - An infection caused by bacteria that starts in the uterus and can spread to other reproductive organs.
- Cervical stenosis - Narrowing of the opening to the uterus.
- Fibroids (benign tumors) - Growths on the inner wall of the uterus.
What are the symptoms of dysmenorrhea?
- Aching pain in the abdomen (pain may be severe at times)
- Feeling of pressure in the abdomen
- Pain in the hips, lower back, and inner thighs
Diagnosis and Tests
How can I know if the dysmenorrhea (pain of menstrual cramps) I'm having is normal?
If you have severe or unusual menstrual cramps or cramps that last for more than 2 or 3 days, contact your healthcare provider. Both primary and secondary menstrual cramps can be treated, so it's important to get checked.
First, you will be asked to describe your symptoms and menstrual cycles. Your healthcare provider will also perform a pelvic exam. During this exam, your doctor inserts a speculum (an instrument that lets the clinician see inside the vagina) and examines your vagina, cervix, and uterus. The doctor will feel for any lumps or changes, and a small sample of vaginal fluid may be taken for testing.
If secondary dysmenorrhea is suspected, further tests may be needed. If a medical problem is found, your healthcare provider will discuss treatments.
If you use tampons and develop the following symptoms, get medical help right away:
- Fever over 102 degrees Fahrenheit
- Dizziness, fainting, or near fainting
- A rash that looks like a sunburn
These are symptoms of toxic shock syndrome, a life-threatening illness.
Management and Treatment
How can I relieve mild dysmenorrhea (pain with mild menstrual cramps)?
To relieve mild menstrual cramps:
- For best relief, you should take ibuprofen as soon as bleeding or cramping starts. You may take aspirin or another pain reliever such as acetaminophen.
- Place a heating pad or hot water bottle on your lower back or abdomen.
- Rest when needed.
- Avoid foods that contain caffeine.
- Avoid smoking and drinking alcohol.
- Massage your lower back and abdomen.
Women who exercise regularly often have less menstrual pain. To help prevent cramps, make exercise a part of your weekly routine.
If these steps do not relieve pain, your health care provider can order medications for you, including ibuprofen or another anti-inflammatory medication (higher dose than is available over-the-counter). Also, oral contraceptives may be prescribed because women who take oral contraceptives have less menstrual pain.
- Womenshealth.gov: Menstruation and the menstrual cycle fact sheet
- American College of Obstetricians and Gynecologists: Dysmenorrhea
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 07/13/2014