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Dysmenorrhea refers to cramps caused by the muscles of the uterus tightening (contracting) during a menstrual period. Dysmenorrhea may be mild, or it may be severe enough to interfere with everyday activities for a few days each month.

Primary dysmenorrhea is menstrual cramps that last a couple of days when you start having menstrual periods or soon after. This often begins after a teenager starts having her period. As a woman gets older or has a baby, the cramps will usually lessen or disappear. Secondary dysmenorrhea begins later in life and is caused by a disorder in the reproductive system. It lasts longer, and it may cause more pain than primary dysmenorrhea. The pain may start before the period and last a few days after the period.

What are the causes?

Dysmenorrhea is usually caused by an underlying problem, such as:

• The tissue that lines the uterus (endometrium) growing outside of the uterus in other areas of the body (endometriosis).
• Endometrial tissue growing into the muscular walls of the uterus (adenomyosis).
• Blood vessels in the pelvis becoming filled with blood just before the menstrual period (pelvic congestive syndrome).
• Overgrowth of cells (polyps) in the endometrium or the lower part of the uterus (cervix).
• The uterus dropping down into the vagina (prolapse) due to stretched or weak muscles.
• Bladder problems, such as infection or inflammation.
• Intestinal problems, such as a tumor or irritable bowel syndrome.
• Cancer of the reproductive organs or bladder.
• A severely tipped uterus.
• A cervix that is closed or has a very small opening.
• Noncancerous (benign) tumors of the uterus (fibroids).
• Pelvic inflammatory disease (PID).
• Pelvic scarring (adhesions) from a previous surgery.
• An ovarian cyst.
• An IUD (intrauterine device).

What increases the risk?

You are more likely to develop this condition if:

• You are younger than age 30.
• You started puberty early.
• You have irregular or heavy bleeding.
• You have never given birth.
• You have a family history of dysmenorrhea.
• You smoke.
  
  

What are the signs or symptoms?

Symptoms of this condition include:

• Cramping, throbbing pain, or a feeling of fullness in the lower abdomen.
• Lower back pain.
• Periods lasting for longer than seven days.
• Headaches
• Bloating
• Fatigue
• Nausea or vomiting.
• Diarrhoea
• Sweating or dizziness.
• Loose stools.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• Blood tests.
• A Pap test. This is a test in which cells from the cervix are tested for signs of cancer or infection.
• A pregnancy test.
• Imaging tests, such as:
   
  • Ultrasound
  • A procedure to remove and examine a sample of endometrial tissue (dilation and curettage, D&C).
  • A procedure to visually examine the inside of:
     
    • The uterus (hysteroscopy).
    • The abdomen or pelvis (laparoscopy).
    • The bladder (cystoscopy).
    • The intestine (colonoscopy).
    • The stomach (gastroscopy).
  • X-rays.
  • CT scan.
  • MRI

How is this treated?

Treatment depends on the cause of the dysmenorrhea. Treatment may include:

• Pain medicine prescribed by your healthcare provider.
• Birth control pills that contain the hormone progesterone.
• An IUD that contains the hormone progesterone.
• Medicines to control bleeding.
• Hormone replacement therapy.
• These may help to stop the production of hormones that cause cramps.
• Antidepressant medicines.
• Surgery to remove adhesions, endometriosis, ovarian cysts, fibroids, or the entire uterus (hysterectomy).
• Injections of progesterone to stop the menstrual period.
• A procedure to destroy the endometrium (endometrial ablation).
• A procedure to cut the nerves in the bottom of the spine (sacrum) that go to the reproductive organs (presacral neurectomy).
• A procedure to apply an electric current to nerves in the sacrum (sacral nerve stimulation).
• Exercise and physical therapy.
• Meditation and yoga therapy.
• Acupuncture

Work with your health care provider to determine what treatment or combination of treatments is best for you.

Follow these instructions at home:

Relieving pain and cramping

• Apply heat to your lower back or abdomen when you experience pain or cramps. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
  • Place a towel between your skin and the heat source.
  • Leave the heat on for 20–30 minutes.
  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.
  • Do not sleep with a heating pad on.
• Do aerobic exercises, such as walking, swimming, or biking. This can help to relieve cramps.
• Massage your lower back or abdomen to help relieve pain.

General instructions

• Take over-the-counter and prescription medicines only as told by your healthcare provider.
• Do not drive or use heavy machinery while taking prescription pain medicine.
• Avoid alcohol and caffeine during and right before your menstrual period. These can make cramps worse.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits as told by your healthcare provider. This is important.

Contact a healthcare provider if:

• You have pain that gets worse or does not get better with medicine.
• You have pain with sex.
• You develop nausea or vomiting with your period that is not controlled with medicine.

Get help right away if:

• You faint.

Summary

• Dysmenorrhea refers to cramps caused by the muscles of the uterus tightening (contracting) during a menstrual period.
• Dysmenorrhea may be mild, or it may be severe enough to interfere with everyday activities for a few days each month.
• Treatment depends on the cause of the dysmenorrhea.
• Work with your healthcare provider to determine what treatment or combination of treatments is best for you.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

References:

Hellman K.M., Datta A., Steiner N.D., et. al.: Identification of experimental bladder sensitivity among dysmenorrhea sufferers. Am J Obstet Gynecol 2018; 219: pp. 84.e1-84.e8.

Iacovides S., Avidon I., Baker F.C.: What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015; 21: pp. 762-778.

Vincent K., Warnaby C., Stagg C.J., Moore J., Kennedy S., Tracey I.: Dysmenorrhoea is associated with central changes in otherwise healthy women. Pain 2011; 152: pp. 1966-1975.

Westling A.M., Tu F.F., Griffith J.W., Hellman K.M.: The association of dysmenorrhea with noncyclic pelvic pain accounting for psychological factors. Am J Obstet Gynecol 2013; 209: pp. 422.e1-422.e10.

Yosef A., Allaire C., Williams C., et. al.: Multifactorial contributors to the severity of chronic pelvic pain in women. Am J Obstet Gynecol 2016; 215: pp. 760.e1-760.e14.

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