Dysmenorrhea
In this condition factsheet:
The Facts on Dysmenorrhea
Dysmenorrhea can be literally translated as "difficult monthly flow." Although it's normal for most people who menstruate to have mild abdominal cramps on the first day or two of their period, about 10% of people who menstruate experience severe pain.
There are 2 types of dysmenorrhea:
- Primary dysmenorrhea is menstrual pain that's not a symptom of an underlying gynecologic disorder but is related to the normal process of menstruation. Primary dysmenorrhea is the most common type of dysmenorrhea, affecting more than 50% of people who menstruate, and quite severe in about 10%. Primary dysmenorrhea is most common in late adolescence and the early 20s. Fortunately for many people, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful.
- Secondary dysmenorrhea is menstrual pain that is generally related to some kind of gynecologic disorder. Most of these disorders can be easily treated with medications or surgery. Secondary dysmenorrhea is more likely to affect people during adulthood.
Causes of Dysmenorrhea
Primary dysmenorrhea is thought to be caused by excessive levels of prostaglandins, hormones that make your uterus contract during menstruation and childbirth. The pain results from the release of these hormones when the lining (endometrium) is sloughing off during your menstrual period. This leads to uterus contraction and decreased blood flow to the uterus.
Factors that may make the pain of primary dysmenorrhea even worse include a uterus that tilts backward (retroverted uterus) instead of forward; longer, heavier, or irregular menstrual periods; lack of exercise; psychological or social stress; smoking; drinking alcohol; being overweight; a family history of dysmenorrhea; and starting menstruating before age 12.
Secondary dysmenorrhea may be caused by a number of conditions, including:
- fibroids – benign tumours that develop within the uterine wall or are attached to it
- adenomyosis – the tissue that lines the uterus (called the endometrium) begins to grow within its muscular walls
- a sexually transmitted infection (STI)
- endometriosis – fragments of the endometrial lining that are found on other pelvic organs
- pelvic inflammatory disease (PID), which is primarily an infection of the fallopian tubes, but can also affect the ovaries, uterus, and cervix
- an ovarian cyst or tumour
- the use of a copper intrauterine device (IUD), a birth control method
Symptoms and Complications of Dysmenorrhea
The main symptom of dysmenorrhea is pain. It occurs in your lower abdomen during menstruation and may also be felt in your hips, lower back, or thighs. Other symptoms may include nausea, vomiting, diarrhea, lightheadedness, headache, or fatigue.
For most people, the pain usually starts shortly before or at the beginning of their menstrual period, peaks around 24 hours after the start of bleeding, and subsides after 2 to 3 days. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain.
Dysmenorrhea pain may be spasmodic (sharp pelvic cramps at the start of menstrual flow) or congestive (deep, dull ache). The symptoms of secondary dysmenorrhea often start sooner in the menstrual cycle than those of primary dysmenorrhea, and usually last longer.
In 5% to 15% of people with primary dysmenorrhea, the pain is severe enough to disturb their daily activities and may result in missed work or school.
