Menstrual Cramps Or Painful Menstruation (Dysmenorrhea) : Symptom, Cause, Diagnosis, Treatment, And Drug

Dysmenorrhea (Menstrual Cramps) is pain during menstruation.Painful menstruation usually begins around the time that menstruation starts.Symptoms of dysmenorrhea often begin immediately following ovulation. They can last until the end of menstruation because dymenorrhea is associated with changes in hormonal levels in the body that occur with ovulation.During menstrual period the uterus contracts to expel its lining.Hormone-like substances prostaglandins involve in pain and inflammation trigger the uterine muscle contractions.Higher levels of prostaglandins are associated with more severe menstrual cramps.Primary dysmenorrhea has also been attributed to behavioral and psychological factors.In primary dysmenorrhea, there is a highly complex interplay between hormones and mediators, basal body temperature, sleep patterns, and the central nervous system (CNS), the extent of which is not completely understood.

Dysmenorrhea can be classified based on the absence or presence of an underlying cause :

• Primary dysmenorrhea is menstrual painthat is not associated with macroscopic  pelvic pathology.It occurs in the absence of pelvic pathology.
• Secondary dysmenorrhea is menstrual pain resulting from anatomic or macroscopic  pelvic pathology.It results from identifiable organic disease.

Clinical features of primary dysmenorrhea include

• Onset shortly after menarche (6 months or up)
• Usual duration of 48-72 hours often starting several hours before or just after the menstrual flow.
• Cramping or laborlike pain.
• Background or constant lower abdominal pain, back or thighs pain.
• Unremarkable pelvic examination findings.

Clinical features of secondary dysmenorrhea include

• Dysmenorrhea begins in the 20s or 30s, after previous relatively painless cycles.
• Heavy menstrual flow or irregular bleeding.
• Dysmenorrhea occuring during the first or second cycles after menarche.
• Pelvic abnormality with physical examination.
• Poor response to non-steroidal anti-inflammatory drugs or oral contraceptives (OCs).
• Infertility
• Vaginal discharge

The Symptoms of Dysmenorrhea

• Nausea
• Vomiting
• Diarrhea or constipation
• Headache
• Dizziness
• Fainting
• Fatigue
• Disorientation
• Hypersensitivity to sound, light, smell, and touch
• Pain in the lower abdomen or pelvis
• Pain in the lower back and thighs

The Cause of  Primary Dysmenorrhea

• Endometriosis is the presence of endometrium like tissue found outside of the uterus, most commonly in ovaries.
• Uterine Fibroids are non-cancerous growths in the wall of the uterus and may be cause the pain.
• Adenomyosis is an invasion of myometrium by uterine adrenal glands.
• Pelvic Inflammatory Disease (PID) is an infection of the uterus and fallopian tubes, with or without ovarian or parametrial involvement.
• Cervical stenosis is the opening of the cervix  may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.

The Common Causes of Secondary Dysmenorrhea

• Uterine Leiomyomata are benign tumors of the uterine musculature that are common cause of dymenorrhea because they enlarge when stimulated by estrogen.
• Adenomyosis is an invasion of myometrium by uterine adrenal glands
• Tubo-Ovarian abscess is a loculated infection within the fallopian tubes or ovaries, usually occuring as a sequela of pelvic inflammatory disease.
• Ovarian Torsion involves twisting of the adnexal structures, which lead to ischemia and ultimately necrosis if the process is not reversed in time.
• Pelvic Inflammatory Disease (PID) is an infection of the uterus and fallopian tubes, with or without ovarian or parametrial involvement.
• Endometriosis is the presence of endometrium like tissue found outside of the uterus, most commonly in ovaries.
• Premenstrual Dysphoric Disorder may have bloating, migraine, body aches, breast tenderness, headache, and emotional complaints.
• Intrauterine Contraceptive Devices (IUCDs) may cause bladder or uterine perforation.

The Risk factors for Primary Dysmenorrhea :

• Earlier age at menarche or before twelve years olds
• Long menstrual periods
• Heavy menstrual flow
• Smoking
• Family history
• Obesity
• Nulliparity

Risk factors of Secondary Dysmenorrhea

• Leiomyomata (Fibroids)
• PID
• Tubo-Ovarian abscess
• Ovarian torsion
• Endometriosis

Diagnosis

Dysmenorrhea diagnosis is made on a medical history of menstrual pain that interferes with daily activity.There is no standard technique for qualifying the severity of painful menstruation.

• Menstrual symptometrics are tthe quantification models to estimate the severity of the menstrual pain as well as correlate them with pain in other parts of the body, menstrual bleeding and degree of interference with daily activities.

Secondary dysmenorrhea is diagnosed by laboratory tests to identify or exclude organic causes of secondary dysmenorrhea

• Complete blood count with differential.
• Gonococcal and Chlamidial cultures, enzyme immunoassay, and DNA probe testing.
• Quantitative human chorionic gonadotropin level.
• Erythrocyte sedimentation rate
• Urinalysis
• Stool guaiac
• Cancer antingen 125 assay

Imaging Studies are used to diagnose if the pelvic pathology is suspected :

• Abdominal or transvaginal ultrasonography
• Hysterosalpingography
• Intravenous pyelography
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Laparoscopy
• Hysteroscopy
• Dilatation and Curettage

Treatment of Dysmenorrhea

1. Pharmacotherapy is to relieve dysmenorrhea effectively.Secondary dysmenorrhea treatment involves correction of the underlying organic cause.
2. Medications approved by FDA (Food and Drug Administration), including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
3. The Intraurine System (Mirena IUD) is to reduce dysmenorrhea symptoms.
4. The supplements are proved effectively to treat dysmenorrhea :

• Omega-3 fatty acids
• Thiamine (Vitamin B1)
• Pyridoxine (Vitamin B6)
• Magnesium
• Vitamin E

5. Physical Activities or exercises are to treat or relieve dysmenorrhea

• Yoga
• Acupuncture
• Homeopathy
• Massage

Drugs for Dysmenorrhea

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.NSAIDs are approved by FDA as follow :

• Diclofenac
• Ibuprofen
• Ketoprofen
• Meclofenamate
• Mefenamic acid
• Naproxen

Other Non-Steroidal Anti-Inflammatory Drugs and Analgesics that have been used :

• Aspirin
• Acetaminophen
• COX-2 Inhibitors
• Montelukast

Oral Contraceptives (OCs) are used for treating dysmenorrhea eventhough these drugs are not approved by FDA (Food and Drug Administration) as below :

• Depot medroxyprogesterone acetate
• Ethynil estradiol with progestin or drospirenone (Combination OCs)
• Levonorgestrel Intrauterine device
• Norplant
• Depo-provera

Caution :
You have to see a doctor if menstrual cramps

• Interfere with the every day life every month
• Get increasingly worse
• Last more than two or three days
• Start after age twenty five
• Accompanied by bleeding, fever, or foul smelling discharge