August 23, 2014
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Pain Management

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Dysmenorrhea



The Facts on Dysmenorrhea

Dysmenorrhea can be literally translated as "difficult monthly flow." Although it's normal for most women to have mild abdominal cramps on the first day or two of their period, about 10% of women experience severe pain.

There are two types of dysmenorrhea:

  • Primary dysmenorrhea is menstrual pain that's not a symptom of an underlying gynecologic disorder but is related to the normal process of menstruation. Primary dysmenorrhea is the most common type of dysmenorrhea, affecting more than 50% of women, and quite severe in about 15%. Primary dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful.
  • Secondary dysmenorrhea is menstrual pain that is generally related to some kind of gynecologic disorder. Most of these disorders can be easily treated with medications or surgery. Secondary dysmenorrhea is more likely to affect women during adulthood.

Causes of Dysmenorrhea

Primary dysmenorrhea is thought to be caused by excessive levels of prostaglandins, hormones that make your uterus contract during menstruation and childbirth. Its pain probably results from contractions of your uterus that occur when the blood supply to its lining (endometrium) is reduced.

Usually, the pain will happen only during menstrual cycles in which an egg is released. The pain may progressively become worse as endometrial tissue shed during a menstrual period passes through the cervix, particularly when the cervical canal is narrow.

Other factors that may make the pain of primary dysmenorrhea even worse include a uterus that tilts backward (retroverted uterus) instead of forward, lack of exercise, and psychological or social stress.

Secondary dysmenorrhea may be caused by a number of conditions, including:

  • fibroids - benign tumours that develop within the uterine wall or are attached to it
  • adenomyosis - the tissue that lines the uterus (called the endometrium) begins to grow within its muscular walls
  • a sexually transmitted infection (STI)
  • endometriosis - fragments of the endometrial lining that are found on other pelvic organs
  • pelvic inflammatory disease (PID), which is primarily an infection of the fallopian tubes, but can also affect the ovaries, uterus, and cervix
  • an ovarian cyst or tumour
  • the use of an intrauterine device (IUD), a birth control method




Symptoms and Complications of Dysmenorrhea

The main symptom of dysmenorrhea is pain. It occurs in your lower abdomen during menstruation and may also be felt in your hips, lower back, or thighs. Other symptoms may include nausea, vomiting, diarrhea, lightheadedness, or general achiness.

For most women, the pain usually starts shortly before or during their menstrual period, peaks after 24 hours, and subsides after 2 to 3 days. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain.

Dysmenorrhea pain may be spasmodic (sharp pelvic cramps at the start of menstrual flow) or congestive (deep, dull ache). The symptoms of secondary dysmenorrhea often start sooner in the menstrual cycle than those of primary dysmenorrhea, and usually last longer.

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