Dysmenorrhea

  1. What is Dysmenorrhea?

    Dysmenorrhea is the term used for painful menstruation. More than half of menstruating women have pain they describe as light in the first days of menstrual bleeding. For some women this pain can be more severe. This depends on personal, hormonal, psychogenic and metabolic differences.

    Menstrual pain is usually localized in the lower abdomen region but can spread to the lower back, upper back and legs. In certain cases, it can also be accompanied by nausea, headache, constipation and diarrhea.

  2. What are the types of Dysmenorrhea?

    There are two types of dysmenorrhea: Primary and secondary. 

    Primary Dysmenorrhea consists of painful menstruation without an underlying condition. It is one of the widely encountered gynecologic complaint. Primary dysmenorrhea is observed in approximately 50% of post-adolescent cases. It is described as a young women's disease as it is mostly observed between the ages of 10 and 20. It might start 1 to 2 years after the first menstruation and can carry on until 40s.

    In primary dysmenorrhea, there are no pathologies in the uterus, ovaries or other organs. The pain usually kicks in with the menstrual bleeding, or 1-2 days prior in certain cases, and intensifies with the start of bleeding. The pain is described as cramps or spasms on the lower abdomen and ends in 48 to 72 hours. In majority of women, pain attacks become less intense with age and following child birth for certain cases.

    Secondary Dysmenorrhea starts at a much later age compared to primary dysmenorrhea and carries an underlying pathology. It is less common than primary dysmenorrhea and can start at any given period in life.

    In secondary dysmenorrhea, the pain can start right before the beginning of menstruation and last throughout the menstrual period. Pain lasts longer than normal cramps, might become more intense during the period and continue after the end of menstruation. It is a blunt pain usually felt in deeper regions and can spread to the lower back.

    The most frequent causes of secondary dysmenorrhea are endometriosis and myoma.

  3. What causes Primary Dysmenorrhea?

    The uterus contracts during menstrual bleeding as it works to discharge accumulated blood when uterine lining is extracted and renewed. During this period, certain glands that activate these contractions such as prostaglandin are secreted. In primary dysmenorrhea patients, the pain is caused either by increased level of prostaglandin or the uterus' response to this secretion.

  4. How is Dysmenorrhea diagnosed?

    The reason for dysmenorrhea can be determined based on a detailed patient history and physical examination. Additional test such as smear, lab tests or ultrasound examination can  also be recommended in order to check for a possible underlying pathology.

  5. How to treat Dysmenorrhea?

    Muscle relaxant hormonal treatment or medication treatment can be recommended for dysmenorrhea whereas surgical intervention is also required in certain cases. Due to the role of prostaglandins in dysmenorrhea, non-steroidal anti-inflammatory pain killers are also recommended. There are many studies conducted on the use of these medications. If the situation persists, birth control pills can be prescribed. Secondary dysmenorrhea treatment on the other hand, is aimed at treating underlying pathologies.

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