What is dysmenorrhea?

Dysmenorrhea causes severe and frequent cramps and pain during your period. It may be either primary or secondary.

• Primary dysmenorrhea. This occurs when you first start your period and continues throughout your life. It is usually life-long. It can cause severe and frequent menstrual cramping from severe and abnormal uterine contractions.

• Secondary dysmenorrhea. This type is due to some physical cause. It usually starts later in life. It may be caused by another medical condition, such as pelvic inflammatory disease or endometriosis.

What causes dysmenorrhea?

Women with primary dysmenorrhea have abnormal contractions of the uterus due to a chemical imbalance in the body. For example, the chemical prostaglandin control the contractions of the uterus.

Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. This is a condition in which endometrial tissue implants outside the uterus. Endometriosis often causes internal bleeding, infection, and pelvic pain.

Other causes of secondary dysmenorrhea include the following:

• Pelvic inflammatory disease (PID)

• Uterine fibroids

• Abnormal pregnancy (miscarriage, ectopic)

• Infection, tumors, or polyps in the pelvic cavity

What are the symptoms of dysmenorrhea?

The following are the most common symptoms of dysmenorrhea. However, each person may experience symptoms differently. Symptoms may include:

• Cramping in the lower abdomen

• Pain in the lower abdomen

• Low back pain

• Pain radiating down the legs

• Nausea

• Vomiting

• Diarrhea

• Fatigue

• Weakness

• Fainting

• Headaches

The symptoms of dysmenorrhea may look like other conditions or medical problems. Always consult your health care provider for a diagnosis.

What are the risk factors for dysmenorrhea?

While any woman can develop dysmenorrhea, the following women may be at an increased risk for the condition:

• Women who smoke

• Women who drink alcohol during their period (alcohol tends to prolong menstrual pain)

• Women who are overweight

• Women who started their periods before the age of 11

• Women who have never been pregnant

Consult your health care provider for more information.

How is dysmenorrhea diagnosed?

To diagnose dysmenorrhea, your health care provider will evaluate your medical history and do a complete physical and pelvic exam. Other tests may include:

• Ultrasound. This test uses high-frequency sound waves to create an image of the internal organs.

• Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body.

• Laparoscopy. This minor procedure uses a laparoscope. This is a thin tube with a lens and a light. It is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the doctor can often detect abnormal growths.

• Hysteroscopy. This is the visual exam of the canal of the cervix and the inside of the uterus. It uses a viewing instrument (hysteroscope) inserted through the vagina.

How is dysmenorrhea treated?

Specific treatment for dysmenorrhea will be determined by your health care provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Cause of the condition (primary or secondary)

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment to manage dysmenorrhea symptoms may include:

• Prostaglandin inhibitors, such as nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin and ibuprofen (to reduce pain)

• Acetaminophen

• Oral contraceptives (ovulation inhibitors)

• Progesterone (hormone treatment)

• Diet changes (to increase protein and decrease sugar and caffeine intake)

• Vitamin supplements

• Regular exercise

• Heating pad across the abdomen

• Hot bath or shower

• Abdominal massage

• Endometrial ablation (a procedure to destroy the lining of the uterus)

• Endometrial resection (a procedure to remove the lining of the uterus).

• Hysterectomy ( the surgical removal of the uterus)

Key points

• Dysmenorrhea is characterized by severe and frequent menstrual cramps and pain during your period.

• Dysmenorrhea may be primary, existing from the beginning of periods, or secondary, due to an underlying condition.

• Symptoms may include cramping or pain in the lower abdomen, low back pain, pain spreading down the legs, nausea, vomiting, diarrhea, fatigue, weakness, fainting, or headaches.

• Treatments may include NSAIDS, acetaminophen, birth control pills, hormone treatment, dietary changes, vitamins, exercise, heat, or massage.

• In extreme conditions, surgery may be needed.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions.