Dysmenorrhea: Causes, Symptoms, and Management
A comprehensive overview of painful menstruation
Introduction
Dysmenorrhea means painful menstruation. It is one of the most common gynecological problems among adolescents and young women. It can interfere with daily life, school/work performance, and quality of life.
Types of Dysmenorrhea
Primary Dysmenorrhea
Painful menstruation without any underlying pelvic disease. Usually starts within 6–12 months after menarche (first period). Caused by increased prostaglandin release, which leads to uterine contractions and pain.
Secondary Dysmenorrhea
Pain due to an underlying pelvic pathology. More common in women above 25 years.
Causes include:
- Endometriosis
- Pelvic inflammatory disease (PID)
- Uterine fibroids
- Adenomyosis
- Intrauterine device (IUD) use
Causes and Risk Factors
Primary dysmenorrhea: Excess prostaglandins, strong uterine contractions, reduced uterine blood flow.
Secondary dysmenorrhea: Structural or pathological pelvic conditions.
Risk factors:
- Early menarche
- Heavy menstrual flow
- Stress and anxiety
- Positive family history
"Early recognition and proper management can significantly improve quality of life for those experiencing dysmenorrhea."
Clinical Features
- Pain: Cramping, spasmodic pain in lower abdomen, radiating to lower back or thighs.
- Onset: Begins a few hours before or with menstruation, lasts 24–72 hours.
- Associated symptoms:
- Nausea, vomiting
- Headache
- Fatigue
- Diarrhea
Diagnosis
Based mainly on history and symptoms.
Pelvic examination and ultrasound to rule out secondary causes.
In adolescents with typical symptoms, often no further investigations are required.
Management
1. General / Lifestyle Measures
- Warm compress or hot water bag on abdomen.
- Regular physical exercise, yoga, and stretching.
- Adequate sleep and stress management.
- Avoid caffeine and smoking.
2. Pharmacological Management
- NSAIDs (e.g., ibuprofen, mefenamic acid): First-line drugs; reduce prostaglandins.
- Oral contraceptive pills (OCPs): Reduce ovulation and endometrial growth → decrease prostaglandins.
- Other options: Hormonal IUD, progesterone therapy.
3. Treatment of Secondary Dysmenorrhea
Treat underlying cause: e.g., surgery for fibroids, antibiotics for PID, hormonal therapy for endometriosis.
Complications
Usually no serious complications in primary dysmenorrhea.
In secondary dysmenorrhea, untreated underlying disease (e.g., endometriosis) may lead to infertility or chronic pelvic pain.
Prevention & Health Education
- Educate girls on normal menstruation and coping strategies.
- Encourage regular exercise and balanced diet.
- Early medical consultation if pain is severe, worsens, or starts later in life (to rule out secondary causes).
Conclusion
Dysmenorrhea is a common but manageable condition.
Early recognition and proper management can improve quality of life.
Lifestyle modification along with medical treatment is highly effective.