Dysmenorrhea | Menstrual pain and cramps

These are painful cramps that occur during or after mensturual periods.

Studies  suggest  that  between 50% and 80% of women will suffer from dysmenorrhoea at some time during their reproductive life, and up to 15% of these women will be seriously debilitated by the condition, with social and economic consequences.

Dysmenorrhea is divided into two categories,

primary and secondary.

Primary dysmenorrhea

Common in women in their teens and early 20's.

Signs and symptoms.

  • There is lower abdominal pain that my sometimes radiate to the thighs.
  • backache
  •  Nausea
  • vomiting
  • light headedness

The symptoms are severe in the first day of the periods and rarely goes beyond two days.

Symptoms are more severe if periods started at a tender age, and extended duration of menstrual flow.

The pain is caused by hormonal imbalance in th uterus(myometrium) and this leads to reduced diameter of the uterine vessels,

leading to reduced blood supply that leads to cramping and pain.

Secondary dysmenorrhoea.

Affects women in their 30's and 40's.

It occurs due to other diseases like pelvic inflamation or endometriosis(a condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain).

The only difference between primary  and secondary dysmenorrhea  is that secondary starts before menstruation and may continue until end of periods.

It is also accompanied by abdominal bloating, backache  and  a general feeling of ‘heaviness’ in the pelvic area. 

Treatment.

Primary dysmenorrhea,

NSAIDs are effective though one has to choose the one that is most effective to the patient.

Mefenamic acid is usually more effective than other NSAIDs due to its other modes of action.

Oral contraceptive pills are usually effective in about 50% of the patients, though this may have attitude issues.

If the cramps are severe then one can use NSAIDs together with hyoscine(buscopan).

Leukotrienes inhibitors like montelukast are also effective.

If NSAIDs fail then try using celecoxib or etoricoxib

Secondary dysmenorrhea.

The doctor should find the underlying cause and treat it.

Example if pelvic inflamatory disease then treat patient for the most frequent causative organisms which are Chlamydia  trachomatis and Neisseria gonorrhoeae.

Summary of treatment options for dysmenorrhoea.

 

 

 

 

 

 

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Dr Mathu

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