Definition

Dysmenorrhea is painful menstruation. It may include pain in the abdomen, back and legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their life. In some women, the pain is severe enough to interfere with normal activities.

There are two types of dysmenorrhea:

  • Primary dysmenorrhea—painful regular (ovulatory) menstrual cycles; the pain is caused by utrine muscle contractions caused by high levels of prostaglandins produced in the lining and body of the uterus after ovulation.
  • Secondary dysmenorrhea—painful periods due to an underlying condition, such as endometriosis (a condition involving the lining of the uterus or womb) or infection, that can begin at any age

Menstrual Flow

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Causes

Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.

Secondary dysmenorrhea can be caused by:

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

Risk factors for primary dysmenorrhea include:

  • Ovulatory menstrual cycles ( a normal physiologic condition)
  • Age: less than 20 years old
  • Early onset of menstruation (less than 12 years old)
  • Depression or anxiety
  • Attempts to lose weight (in women 14-20 years old)
  • Heavy bleeding during periods
  • Nulliparity (never having delivered a baby)
  • Smoking

The presence of a known cause of secondary dysmenorrhea (see “Causes”) is a risk factor for developing the condition.

Symptoms

The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing or dull and aching, depending on the individual. It is most typically located in the lower abdomen and may radiate to the low back or thighs. Other symptoms may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Irritability

Diagnosis

Your doctor will ask detailed questions about your symptoms and medical history, and perform a pelvic examination.

Diagnostic tests may include:

  • Pelvic ultrasound—a test that uses sound waves to examine structures in the pelvis
  • Pelvic laparoscopy—a thin, lighted tube inserted through a small incision in the abdomen to view structures in the pelvis

These tests are usually performed to look for causes of secondary dysmenorrhea.

Treatment

The treatment of secondary dysmenorrhea varies depending on the underlying condition (for example, antibiotics for an infection or surgery to remove fibroids).

Primary dysmenorrhea is usually treated with medications and lifestyle changes.

Medications

  • Nonsteroidal anti-inflammatory drugs (NSAIDS)
  • Oral contraceptives

Other Treatments

  • Using a heating pad on your abdomen or taking a warm bath can relieve discomfort.
  • Some herbs and supplements may be helpful, such as B1, magnesium, and Chinese Herbal Medicine.
    • Talk to your doctor before taking any herbs and supplements. They may interact with your other medications and conditions.
  • Acupuncture can reduce pain.*

Prevention

To help reduce your chance of getting dysmenorrhea, take the following steps:

  • Exercise regularly.
  • If you smoke, quit.
  • Drink only moderate amounts of caffeine and alcohol.