Dysmenorrhea

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[edit] Dysmenorrhea

Introduction

Menstrual periods can be painful without an obvious cause. This is labeled "primary dysmenorrhea" or "functional dysmenorrhea" meaning in plain English "painful periods" . In other cases a cause can be found and this is called "secondary dysmenorrhea" or "acquired dysmenorrhea". Some of the causes for acquired dysmenorrhea are: a narrow cervical canal or a polyp blocking the cervical canal.

Endometriosis and adenomyosis are also frequent causes, which is a condition where the lining of the uterus grows into the wall of the uterus (adenomyosis) or grows through the tube onto the ovaries.

Sometimes the endometriosis even grows onto the surrounding bowel in the pelvis and can cause an acute emergency, particularly when there is associated bleeding into the abdominal cavity.

With menstruation this tissue tends to bleed and causes often painful periods. With primary dysmenorrhea despite a thorough work-up by the specialist no cause can be found. It is thought that prostaglandins are likely to blame, which originate from the edometrial lining of the uterus and lead to uterine contractions.

Symptoms:

With dysmenorrhea there is pain in the lower midabdominal region, which is crampy, sometimes even colicky. The latter acute presentation is often associated with the passage of membranes and blood clots (called"membranous dysmenorrhea"). There are often generalized symptoms such as nausea, sometimes vomiting and headaches. The abdominal pain may also radiate into the lower back or into both legs. The woman with dysmenorrhea may also urinate more often and complain of constipation or diarrhea.

Treatment:

The physician needs to examine the patient and if everything checks out O.K., reassure the patient that everything is normal.

Treatment for dysmenorrhea:

The doctor likely will recommend that a woman with dysmenorrhea take a prostaglandin synthetase inhibitor 1 or 2 days before the menstrual period begins and to continue this until 1 or 2 days after it finished.

Popular prostaglandin inhibitors are: ibuprofen (brand names: Motrin, Advil, Ibu, Rufen), naproxen (brand name: Anaprox, Synflex), mefenamic acid (brand names: Ponstan, Ponstel). Essentially these medications help to reduce the prostaglandin, which is released around the time of the menstruation thus relieving the cramps and pain in the uterus. However, it only works optimally when the woman takes it early enough as otherwise the prostaglandins already released into the system will continue to produce symptoms.

If this medication does not work, the doctor likely will suggest an oral contraceptive, not for the purposes of avoiding pregnancy, but because it has been shown in the past that women with dysmenorrhea got surprising relief with the birth control pill. The standard low-dose estrogen-progesterone contraceptive pills will suppress ovarian function and this way help to normalize the periods and avoid the prostaglandin induced pain cycle. Your doctor will advise you which BCP to take, but some of the more common ones are listed here: Cyclen, Tri-Cyclen, Lo/Ovral, Desogen, Ortho7/7/7, Ovcon, Tri-Norinyl, Genora, Min-Ovral, Nordette and many others.

If this does not help, it is advisable to ask for a referral to a gynecologist in order to have more testing done.

The newest treatment modality for women who are beyond the reproductive phase of life, but wish to keep their uterus, may want to consider endometrial ablation, which is a conservative operative procedure using a heat sound to remove the lining of the uterus. The link explains this in detail. This is a reasonable alternative to the conventional, but more invasive hysterectomy.

References:

1. DM Thompson: The 46^th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

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