Dysmenorrhea (Painful Menstruation)
What Is Dysmenorrhea?
Dysmenorrhea means pain just prior to and/or during menses.
What Causes Dysmenorrhea?
The most common reason patients experience painful menses is because of inflammatory agents, called prostaglandins, which are released from the lining of the uterus during menstruation. Rarely, other conditions including endometriosis, uterine abnormalities, or ovarian masses may cause painful menses.
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What Are the Signs and Symptoms of Dysmenorrhea?
The most common symptom is crampy, lower abdominal/pelvic pain that occurs just prior to and/or throughout the menses. Most patients experience the most intense pain at the beginning of the menstrual bleeding.
Patients may also experience other symptoms during their menses including:
- Nausea and vomiting
- Bloating
- Constipation
- Diarrhea
- Headache
- Back pain
- Muscle aches
- Generalized fatigue
How Is Dysmenorrhea Diagnosed?
Talking with the patient and taking a careful history is the most important step in evaluating a patient with painful menses. Oftentimes a careful history combined with seeing how a patient’s symptoms respond to standard therapy is the only intervention needed. Infrequently, a limited physical exam may be required to assess anatomy or a transabdominal pelvic ultrasound to evaluate the uterus and ovaries. A speculum exam and/or Pap test is rarely indicated.
How Is Dysmenorrhea Treated?
Typical treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent the pain caused by the prostaglandins. Hormonal contraception is also commonly used either alone or along with NSAIDs. Hormonal contraception alleviates pain by decreasing prostaglandin production. There are many safe and effective options to treat painful periods and prevent them from negatively impacting a young woman’s quality of life.
