Dysmenorrhea (patient information)
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Dysmenorrhea |
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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Painful menstrual periods during which a woman experiences either a 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