Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. Dysmenorrhea may be classified as primary or secondary.
- Primary dysmenorrhea. From the beginning and usually lifelong; severe and frequent menstrual cramping caused by severe and abnormal uterine contractions.
- Secondary dysmenorrhea. Due to some physical cause and usually of later onset; painful menstrual periods caused by another medical condition present in the body (like pelvic inflammatory disease or endometriosis).
The cause of dysmenorrhea depends on whether the condition is primary or secondary. In general, females with primary dysmenorrhea experience abnormal uterine contractions as a result of a chemical imbalance in the body (particularly prostaglandin and arachidonic acid. These are chemicals that control the contractions of the uterus). Secondary dysmenorrhea is caused by other medical conditions, most often endometriosis. This is a condition in which tissue that looks and acts like endometrial tissue becomes implanted outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. This often results in internal bleeding, infection, and pelvic pain. Other possible causes of secondary dysmenorrhea include the following:
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Abnormal pregnancy (like miscarriage, ectopic)
- Infection, tumors, or polyps in the pelvic cavity
The following are the most common symptoms of dysmenorrhea. However, each adolescent 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
How is dysmenorrhea diagnosed?
Diagnosis begins with a health care provider evaluating a female's medical history and a complete physical examination including a pelvic examination. A diagnosis of dysmenorrhea may require your health care provider to rule out other menstrual disorders, medical conditions, or medicines that may be causing or aggravating the condition. In addition, diagnostic procedures for dysmenorrhea may include:
- Ultrasound (also called sonography). A diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function. And to assess blood flow through various vessels.
- Laparoscopy. A minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic and abdomen area, the health care provider can often find abnormal growths.
- Hysteroscopy. A visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Specific treatment for dysmenorrhea will be determined by your adolescent's health care provider based on:
- Her age, overall health, and medical history
- Extent of the condition
- Cause of the condition (primary or secondary)
- Her tolerance for specific medicines, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
- Prostaglandin inhibitors, for example, nonsteroidal anti-inflammatory medicines, like aspirin or ibuprofen, to reduce pain
- Oral contraceptives (ovulation inhibitors)
- Progesterone (hormone treatment)
- IUD with progesterone
- Dietary modifications (to increase protein and to decrease sugar and caffeine intake)
- Vitamin supplements
- Regular exercise
- Heating pad across the stomach
- Hot bath or shower
- TENS unit (Transcutaneous electrical nerve stimulation)
- Abdominal massage