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Dysmenorrhea - Pain During Menstruation

By Liji Thomas, MD

Dysmenorrhea refers to the presence of pain during menstruation, usually in the lower abdomen, but sometimes in the back. It can be sharp, aching or cramping pain.

Primary dysmenorrhea

This type starts within six months of having the first period. It is not a result of any uterine, tubal or ovarian disease. It lasts less than 72 hours, starting just before or after the period starts. It is thought to be due to uterine cramping as a result of prostaglandin action during this phase of the cycle.

Secondary dysmenorrhea

This type starts up in a woman who had previously painless periods, and may be associated with;

  • Infertility
  • Discharge from the vagina
  • Pain during intercourse or pelvic examination

It is often due to conditions like

  • Uterine fibroids
  • Pelvic inflammation or infection
  • Sexually transmitted infection
  • Endometriosis
  • Copper-containing intrauterine contraceptive device

Home remedies

  • Heat pad over the site of pain
  • Over-the-counter pain relievers like Ibuprofen or mefenamic acid, with or without antispasmodics such as dicyclomine
  • Gentle massage over the painful part
  • Warm drinks
  • Eat more complex carbs like whole grains, unrefined sugar and vegetables and fruits
  • Drink plenty of water
  • Keep your lower limbs elevated when you lie down
  • Take regular exercise
  • Try to lose some weight
  • Take supplements of the B vitamins with antioxidants, calcium and magnesium
  • Pelvic rocking exercise may be helpful

Signs that you need medical care:

  • Pain that starts out of the blue
  • Prolonged pain, starting before your period and lasting after it ends
  • Pain that gets worse as the period progresses
  • Pain accompanied by itching or bad-smelling vaginal discharge
  • Fever with pain
  • Pain after a late period starts, especially if you could have been pregnant
  • You have pain more than 3 months after having an IUD placed
  • You have increased bleeding with pain
  • Pain at times outside your period time
  • Pain not relieved by birth control pills or pain relievers

Diagnosis

To differentiate the various causes of dysmenorrhea, physical examination and tests may be needed. They include blood work and cultures for infection. Tests are also done to rule out pregnancy and tumors. A pelvic ultrasound is helpful to identify pelvic disease. Other imaging tests like laparoscopy may be recommended based on earlier test findings.

Treatment

Management depends on the cause. Smoking is a definite risk factor and should be stopped.

Other methods could include:

  • Birth control pills, patches, vaginal rings, implants
  • Changing the IUD to another one containing progestin
  • Antibiotics
  • Pain relieving drugs
  • Surgery in some cases

Last Updated: Mar 12, 2015

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