DYSMENORRHEA
Dysmenorrhea is painful menstruation and is the most common of all gynecologic conditions. Menstrual cramps refer to the throbbing pain in the lower belly many women feel just prior to and during menstrual periods. For a number of women, the discomfort is only irritating. For others, it can be terrible enough to get in the way with daily activities for a few days every month.
There are two kinds of dysmenorrhea. In primary dysmenorrhea, there is no physical abnormality and it usually starts within three years after one begins menstruating. Secondary dysmenorrhea has an underlying physical cause (endometriosis or uterine fibroids).
CAUSES
Some conditions that can cause secondary dysmenorrhea:
- Pelvic Inflammatory Disease (PID)—an infection of the female reproductive organs usually caused by sexually transmitted bacteria.
- Endometriosis--a painful condition wherein the kind of tissue that lines the uterus becomes implanted outside the uterus, most usually the fallopian tubes, ovaries or the tissue the pelvis.
- Uterine fibroids and uterine polyps—noncancerous tumors and growths jutting from the lining of the uterus.
- Use of an Intrauterine Device (IUD)—when these small, plastic, T-shaped birth control mechanisms are introduced into the uterus, they may cause heightened cramping, mainly during the first few months after insertion.
DIAGNOSIS & SYMPTOMS
The doctor will review the patient’s medical history and do a physical examination (a pelvic exam). During the pelvic exam, the doctor will test for any defects in the reproductive organs and look for signs of infection.
To rule out other causes of the symptoms or to spot the cause of secondary dysmenorrhea, the doctor may ask for diagnostic tests, such as:
Imaging tests--Noninvasive tests that allow the doctor to look for abnormalities within the pelvic cavity. These include computerized tomography (CT), ultrasound, and magnetic resonance imaging (MRI).
Laparoscopy--A surgical procedure involving the doctor viewing the pelvic cavity by making tiny incisions in the abdomen and introducing a fiber-optic tube with a small camera lens.
Hysteroscopy—A procedure where the doctor inserts an instrument through the vagina and cervical canal to observe the cervical canal and the inside of the uterus.
TESTS & TREATMENT
For secondary dysmenorrhea, the patient will require treatment for the underlying cause. Basing on the cause, management can include antibiotics to treat infection or surgery to take out fibroids or polyps.
The patient may be able to diminish the discomfort from dysmenorrhea by using an over-the-counter nonsteroidal anti-inflammatory drug (aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve). Self-care approaches may also help alleviate soreness. For serious cramping, the doctor may advise low-dose oral contraceptives to put off ovulation, which may decrease the production of prostaglandins and consequently the severity of the cramps.
COMPLICATIONS
The complications of secondary dysmenorrhea are based on the underlying cause. Some possible complications are:
- Harsh pain that often hinders with normal activity.
- Pelvic inflammatory disease can wound the fallopian tubes and affect reproductive health. The scarring can result to an ectopic pregnancy,
- Endometriosis, another likely cause of secondary dysmenorrhea, can lead to damaged fertility.
PREVENTIONS
- Smokers tend to be more at risk for dysmenorrhea than nonsmokers so smokers with the condition are strongly advised to quit.
- Medicines can both avert and treat painful cramps.
- Epidemiological studies illustrate that overweight women are more at risk for dysmenorrhea. Losing excess weight may help lessen the severity of cramps.
- Hormonal techniques of birth control and ”anti-prostaglandin” medicines like ibuprofen or naproxen taken 48 hours before the beginning of menses may prevent cramps.
INCIDENCE & STATISTICS
The peak incidence of primary dysmenorrhea happens in late teens and the early 20s. The incidence of dysmenorrhea in adolescents is allegedly as high as 92%. The incidence drops with a rise in age.
In an epidemiologic survey of an adolescent population (aged 12-17 years), Klein and Litt reported an occurrence of dysmenorrhea of 59.7%. Of patients reporting pain, 12% depicted it as acute; 37%, as average; and 49%, as mild. Dysmenorrhea caused 14% of patients to neglect school often.
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