Dysmenorrhea (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.

Synonyms and Keywords: Dysmenorrhea; Menstrual cramps

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

Considerations

 * 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

When to seek urgent medical care?

 * 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.

Diagnosis

 * 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

Treatment options

 * 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.

Home care

 * 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)

Where to find medical care for Dysmenorrhea?
Directions to Hospitals Treating Dysmenorrhea

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