different women though are usually consistent
from period to period in an individual woman.
These symptoms may include
- crampy pain in the lower abdomen, often
extending into the lower back and sometimes
occurring in a combination of steady cramps
with intermittent spasms or outright pain - sensation of heaviness in the lower abdomen
- bloating (fluid retention)
- HEADACHE
- NAUSEAandVOMITING
- bowel disturbances (CONSTIPATIONor DIARRHEA)
- fatigue
Symptoms often vary in severity over the
course of the menstrual period, typically being
more severe during the first two to three days of
menstrual bleeding. About 10 percent of women
who have dysmenorrhea have symptoms severe
enough to prevent their participation in regular
daily activities. The diagnostic path begins with a
medical examination that includes a comprehen-
sive health history (including history of sexual
activity), PELVIC EXAMINATION, PAP TEST, and labora-
tory tests for SEXUALLY TRANSMITTED DISEASES(STDS).
Any abnormal findings suggest secondary dys-
menorrhea and require additional assessment and
appropriate diagnostic procedures. Normal find-
ings establish a presumed diagnosis of primary
dysmenorrhea.
Treatment Options and Outlook
Medications are the first choice of treatment for
primary dysmenorrhea. Those that provide the
greatest level of relief are NONSTEROIDAL ANTI-
INFLAMMATORY DRUGS (NSAIDS), which block the
release of prostaglandins, and oral contraceptives
(birth control pills), which regulate the
estrogen–progesterone balance as well as reduce
prostaglandin release. Some women obtain ade-
quate relief from over-the-counter NSAIDs; other
women require stronger prescription NSAIDs. For
severe dysmenorrhea that does not improve with
these treatments, the gynecologist may recom-
mend extended cycle oral contraceptives, a ther-
apy that reduces the frequency of menstrual
periods to every three months, orHORMONE THER-
APYto suppress menstruation up to 12 months.
Lifestyle and complementary methods for relief of
symptoms include ACUPUNCTURE, thiamine supple-
mentation, herbal therapies, dietary changes to
decrease inflammation, heat to the lower
abdomen or back, progesterone cream, and daily
physical exercise. Treatment for secondary dys-
menorrhea targets the underlying condition as
well as symptom relief.MEDICATIONS TO TREAT DYSMENORRHEA
diclofenac ethinyl estradiol and
ethinyl estradiol and norethindrone
norgestimate ibuprofen
ketoprofen meclofenamate
mefenamic acid naproxenRisk Factors and Preventive Measures
Menstrual cramps and associated discomforts are
very common among menstruating women.
Women who have a heavy menstrual flow, who
have not carried a pregnancy to term, or who
smoke cigarettes are more likely to have dysmen-
orrhea. Physical inactivity, OBESITY, and chronic
PELVIC INFLAMMATORY DISEASE(PID) may also influ-
ence dysmenorrhea. Health conditions that may
exacerbate dysmenorrhea include DYSFUNCTIONAL
UTERINE BLEEDING(DUB), endometriosis, and uterine
fibroids. Because dysmenorrhea occurs only
among menstruating women, the end of menstru-
ation brings the end of dysmenorrhea. Circum-
stances that end menstruation include MENOPAUSE
(the natural cessation of the menstrual cycle that
occurs with aging), HYSTERECTOMY (surgical
removal of the uterus), and some treatments for
cancer such as CHEMOTHERAPYorRADIATION THERAPY
to the abdomen.
See also AMENORRHEA; CONTRACEPTION; EXERCISE
AND HEALTH; HYPERTHYROIDISM; HYPOTHYROIDISM; PRE-
MENSTRUAL SYNDROME(PMS); SEXUALLY TRANSMITTED
DISEASE(STD) PREVENTION; SMOKING AND HEALTH.270 The Reproductive System