Dysmenorrhoea , also known as painful period , or menstrual cramp , is a pain during menstruation. The usual onset around the time of menstruation begins. Symptoms usually last less than three days. Pain is usually in the pelvis or lower abdomen. Other symptoms may include back pain, diarrhea, or nausea.
In young women, painful periods often occur without underlying problems. In older women it is more often due to underlying problems such as uterine fibroids, adenomyosis, or endometriosis. It's more common among those with heavy periods, irregular periods, whose period begins before the age of twelve, or who has low weight. Pelvic examination in those who are sexually active and ultrasound may be useful to assist in diagnosis. Conditions to be ruled out include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis, and chronic pelvic pain.
Dysmenorrhea is less common in those who exercise regularly and those who have children at an early age. Treatment may include use of a heating pad. Medicines that can help include NSAIDs such as ibuprofen, hormonal birth control, and IUDs with progestogens. Taking vitamin B or magnesium may help. Evidence for yoga, acupuncture, and massage is not enough. Surgery may be useful if certain fundamental problems are present.
Estimated percentage of women of reproductive age affected varies from 20 to 90%. This is the most common menstrual disorder. It usually starts within one year of the first menstrual period. When there is no underlying cause often the pain improves with age or after having a child.
Video Dysmenorrhea
Signs and symptoms
The main symptom of dysmenorrhea is a concentrated pain in the lower abdomen or pelvis. It is also commonly felt on the right or left side of the abdomen. It may be radiating to the thigh and lower back.
Symptoms that often occur along with menstrual pain include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, odor and touch, fainting, and fatigue. Dysmenorrhea symptoms often begin immediately after ovulation and may last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormone levels in the body that occur with ovulation. The use of certain types of birth control pills can prevent symptoms of dysmenorrhea because they stop ovulation.
Maps Dysmenorrhea
Cause
Dysmenorrhea may be classified as primary or secondary based on the absence or underlying cause. Secondary dysmenorrhea is dysmenorrhea associated with existing conditions.
The most common cause of secondary dysmenorrhea is endometriosis, which can be visually confirmed by laparoscopy in about 70% of adolescents with dysmenorrhea.
Other causes of secondary dysmenorrhea include leiomyomas, adenomyosis, ovarian cysts, and pelvic congestion.
Unequal leg length may be hypothetically one contributor, as it may contribute to an inclined pelvis, which can cause lower back pain, which in turn may be a mistake for menstrual pain, as women with lower back pain experience increased pain during their menstruation.
Other skeletal abnormalities, such as scoliosis (sometimes caused by spina bifida) may also be contributors.
Mechanism
During the woman's menstrual cycle, the endometrium thickens in preparation for a potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the formed uterine tissue is not needed and thus released.
A molecular compound called prostaglandin is released during menstruation, due to the destruction of endometrial cells, and the release resulting from its contents. The release of prostaglandins and other inflammatory mediators in the uterus causes the uterus to contract. These substances are considered a major factor in primary dysmenorrhea. When the uterine muscles contract, they constrict the blood supply to the endometrial tissue, which, in turn, breaks and dies. This contraction of the uterus continues as they suppress the old endometrium tissue that dies through the cervix and out of the body through the vagina. This contraction, and the temporary shortage of oxygen produced to adjacent tissues, is responsible for the pain or "cramp" experienced during menstruation.
Compared with other women, women with primary dysmenorrhea experience increased uterine muscle activity with increased contractility and increased frequency of contractions.
In one study study using MRI, features seen from the uterus were compared in dysmenorrhea and eumororic participants (normal). The study concluded that in dysmenorrheic patients, the features seen in the days of cycles 1-3 correlated with the level of pain, and differed significantly from the control group.
Diagnosis
Diagnosis of dysmenorrhea is usually made only in the medical history of menstrual pain that interferes with daily activities. However, there is no universally accepted gold standard technique for measuring the severity of menstrual pain. However, there is a quantification model, called menstrual symptoms, which can be used to estimate the severity of menstrual pain and link them with pain in other parts of the body, menstrual bleeding and the level of disturbance with daily activities.
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Once the diagnosis of dysmenorrhea is made, further examination is needed to find the underlying secondary cause, in order to specifically treat it and to avoid the aggravation of underlying causes that may be serious.
Further examination includes specific medical history of symptoms and menstrual cycle and pelvic examination. Based on the results of this, additional exams and tests can be motivated, such as:
- Laboratory test
- Gynecological ultrasonography
- Laparoscopy may be required.
Management
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving primary dysmenorrhea pain. They can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea. People who are unable to take more common NSAIDs may be prescribed COX-2 inhibitors.
Hormonal birth control
The use of hormonal contraceptives can improve the symptoms of primary dysmenorrhea. However, a systematic review of 2009 found limited evidence that birth control pills, which contain low doses or moderate doses of estrogen, relieve pain associated with dysmenorrhea. In addition, there was no difference between the different preparations of birth control pills found.
Norplant and Depo-provera are also effective, as this method often leads to amenorrhea. The intrauterine system (Mirena IUD) may be useful in relieving symptoms.
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A review shows the effectiveness of transdermal nitroglycerin.
Alternative medicine
There is no sufficient evidence to recommend the use of herbal or dietary supplements to treat dysmenorrhea, including, melatonin, vitamin E, fennel, dill, chamomile, cinnamon, damask rose, rhubarb, guava and uzara. Further research is recommended to follow up on weak evidence of benefits for: fenugreek, ginger, valerian, zataria, zinc sulfate, fish oil, and vitamin B1. The 2016 review found that insufficient safety evidence for all dietary supplements.
There is some conflicting evidence in the scientific literature, including:
One review found thiamine and vitamin E may be effective. He found the effects of fish oil and vitamin B12 unknown.
The review found tentative evidence that ginger powder may be effective for primary dysmenorrhea.
Reviews have found promising evidence for Chinese herbal medicine for primary dysmenorrhoea, but the evidence is limited by poor methodological quality.
Procedures
Acupuncture: The Cochrane 2016 review found that randomized controlled trials (RCT) from acupuncture treatment for dysmenorrhea were of poor quality and concluded that it is not known whether acupuncture or acupressure is effective for treating primary dysmenorrhea symptoms. There are also bias concerns in research design and in publications, insufficient reporting (few see side effects), and that they are inconsistent. There are conflicting reports in the literature, including one review that found that acupressure, topical heat, transcutaneous electrical nerve stimulation, and behavioral intervention may be effective. He found the effects of acupuncture and magnetism unknown.
The 2007 systematic review found some scientific evidence that behavioral intervention may be effective, but the results should be viewed with caution because of poor data quality.
Spinal manipulation does not seem to help. Although claims have been made for chiropractic care, under the theory that treating subluxation in the spine may decrease symptoms, a systematic review in 2006 found that overall there is no evidence to suggest that spinal manipulation is effective for the treatment of primary and secondary dysmenorrhea.
Epidemiology
Dysmenorrhea is thought to affect about 25% of women. The dysmenorrhea report is greatest among individuals in late teens and 20s, with reports usually declining with age. Prevalence in adolescent women has been reported to be 67.2% by one study and 90% by others. It has been stated that there is no significant difference in the prevalence or incidence of race. However, the study of Hispanic adolescent females showed high prevalence and impact in this group. Another study showed that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity. Childbirth is said to remove dysmenorrhea, but this is not always the case. One study showed that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40. A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in women who had been sexually abused.
A survey in Norway showed that 14 percent of women between the ages of 20 to 35 had symptoms so severe that they remained at home from school or at work. Among adolescent girls, dysmenorrhea is a major cause of repeated short-term school absenteeism.
References
External links
- Dysmenorrhea in Curlie (based on DMOZ)
Source of the article : Wikipedia
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