Dysmenorrhea
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Dysmenorrhea (or dysmenorrhoea), cramps or painful menstruation, involves menstrual periods that are accompanied by either sharp, intermittent pain or dull, aching pain, usually in the pelvis or lower abdomen.
Painful menstruation affects approximately 40% of menstruating women, and 10% are incapacitated for up to 3 days. Painful menstruation is the leading cause of lost time from school and work among women of childbearing age. This pain may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off.
Although some pain during menstruation is normal, excessive pain is not. Dysmenorrhea refers to menstrual pain severe enough to limit normal activities or require medication.
There are two general types of dysmenorrhea:
- Primary dysmenorrhea refers to menstrual pain that occurs in otherwise healthy women. This type of pain is not related to any specific problems with the uterus or other pelvic organs.
- Secondary dysmenorrhea is menstrual pain that is attributed to some underlying disease process or structural abnormality either within or outside the uterus (for example, pelvic inflammatory disease, fibroids, endometriosis, adhesions, adenomyosis, or uterine displacement). Endometriosis is the most common cause of dysmenorrhea associated with a disease process and is frequently misdiagnosed.
Activity of the hormone prostaglandin is thought to be a factor in primary dysmenorrhea. Prostaglandin levels have been found to be much higher in women with severe menstrual pain than in women who experience mild or no menstrual pain.
The presence of an IUD (intrauterine device) for contraception may be a potential cause of menstrual pain, although they usually lead to pelvic pain only around the time of insertion. Some women also find that use of tampons exacerbates menstrual cramps and pain.
Psychological distress, often accompanied by physical pain and bloating, is commonly known as premenstrual syndrome (PMS). Symptoms include stress, anxiety, depression, irritability, mood swings, and crying jags. If these symptoms are severe enough to interfere with work or relationships, the condition is known as premenstrual dysphoric disorder (PMDD), and medications such as antidepressants may be helpful for treatment.
The incidence of menstrual pain is greatest in women in their late teens and 20s, then declines with age. Some women experience increased menstrual pain in their late 30s and 40s as their endocrine systems prepare for menopause by decreasing hormone levels and thus fertility. It does not appear to be affected by childbearing. An estimated 10 percent to 15 percent of women experience monthly menstrual pain severe enough to prevent normal daily function at school, work, or home.
The majority of women will suffer this degree of disability at least once during their reproductive years. Increased risk is associated with younger age, and past medical history of any of the conditions associated with secondary dysmenorrhea.
Common Causes
- Premenstrual syndrome (PMS)
- Stress and anxiety
- Pelvic inflammatory disease
- Adenomyosis
- Multiple sexual partners
- History of sexual or physical abuse
- Fibroids
- Ovarian cysts
- Endometriosis