Dysmenorrhea: Causes, Symptoms, and Treatment
Dysmenorrhea (Greek disband + menorrhagia, pain) is a term referring to painful menstruation. It is a medical condition characterized by painful menstruation. It affects women’s reproductive system and causes them pain during their menstrual cycle. Menstrual cramps are caused by uterine contractions and pain throughout the uterus. These contractions cause pressure and discomfort around the uterus and lower abdomen. Painful menstrual cramps often begin before ovulation and last until after menses have begun.
It is a condition where women experience painful cramps before their period. These cramps may last anywhere between 2-10 days and can vary in intensity. The pain associated with dysmenorrhea is caused due to increased uterine contractions. This causes the uterus to squeeze blood out of the vessels, causing them to swell. As a result, these swollen veins create pressure on nearby nerves, resulting in menstrual cramps.
In some cases, the pain may start before the period starts but not always. Generally, people feel worse on the first day of their menstrual cycle. If they have no symptoms at all, then they should wait until they begin experiencing severe cramps. The pain can last anywhere from 1-72 hours whereas usually, it lasts for 2 – 6 days. A woman’s body releases prostaglandin E2 (PGE2) which causes uterine contractions. These contractions are what cause the pain associated with period pains.
Research says what?
According to the American College of Obstetricians & Gynecologists, over 80% of women suffer from some sort of premenstrual symptoms at least once in their lifetime. It’s estimated that 90% of women have had menstrual headaches at some point. To keep things under control, here are some tips to help ease the discomfort of menstrual cramps.
What are the types of Dysmenorrhea?
There are two types of dysmenorrhea.
- Primary dysmenorrhea is due to increased levels of PGE2 which can lead to uterine spasms causing intense pain.
- Secondary dysmenorrhea occurs due to endometriosis, adenomyosis, fibroids, pelvic inflammatory disease, cervical stenosis, thyroid problems, and depression.
What can be the cause of this condition?
The exact cause of dysmenorrhea remains unclear. However, some factors may contribute to its occurrence. These include hormonal changes, pelvic inflammatory disease (PID), uterine fibroids, adenomyosis, and cervical stenosis.
Hormonal changes occur during puberty and pregnancy. Pregnancy increases estrogen levels, causing increased blood flow to the uterus. Estrogen stimulates prostaglandins, which increase contractions of the smooth muscle lining of the uterus. PID is a bacterial infection that can affect the fallopian tubes, ovaries, cervix, vagina, bladder, urethra, rectum, and anus. These benign tumors develop inside the uterus. Adenomyosis is a type of abnormal growth of the inner wall of the uterus. Cervical stenosis is the narrowing of the opening of the birth canal.
Diagnosing endometriosis is difficult. Doctors often rely on physical examination and imaging tests to determine if someone has endometriosis. A physical exam includes checking for any abnormalities in the pelvis. Imaging tests like ultrasound and MRI scan help doctors identify whether there’s anything wrong with the reproductive system.
If your doctor suspects that you have endometriosis, he/she might recommend doing periodic blood testing to check hormone levels. Hormone level testing helps doctors monitor changes in estrogen and progesterone levels. A woman who has endometriosis should not take birth control pills unless her doctor approves them. Birth control pills increase the risk of bleeding and spotting.
Symptoms vary depending on the severity of the condition. In mild cases, symptoms include cramps, lower abdominal discomfort, bloating, nausea, vomiting, diarrhea, fatigue, headache, backache, and leg swelling. Severe cases may result in severe pain, fever, chills, dizziness, fainting, blurred vision, chest pains, shortness of breath, irregular heartbeat, and even shock.
Treatments of Dysmenorrhea
Treatments for dysmenorrhea depend on the underlying cause. If the problem is not serious enough to warrant treatment, then no treatment is necessary. However, if the condition persists, treatments include nonsteroidal anti-inflammatory drugs (NSAIDs) and hormone therapy. NSAIDs relieve pain by blocking the production of prostaglandin E2, a chemical responsible for triggering uterine contractions. Hormone therapy involves taking oral contraceptives or progesterone injections to reduce the amount of estrogen produced by the body.
Other treatment options include painkillers, hormone therapy, birth control pills, acupuncture, herbal remedies, physiotherapy, and surgical procedures
- Acupuncture: Acupuncture is the use of fine needles to stimulate certain points along the body’s meridians to relieve pain and promote healing. When done correctly, acupuncture can have long-lasting effects on those who experience chronic pain. A study published in 2000 revealed that people undergoing acupuncture experienced significantly less pain than people taking conventional treatment.
- Herbal Remedies: Many herbs and natural remedies exist for treating dysmenorrhea. Many of these treat the symptoms, while others attack the root of the problem. Chinese medicine treats pain by stimulating the flow of qi throughout the pelvic area and restoring energy levels to the organs. Other homeopathic treatments focus on increasing blood flow and thus relieving pain. Herbs that have documented effectiveness include fennel, chamomile, alfalfa, nettle, horsetail, black cohosh, red clover, evening primrose oil, and ginger.
- Diet Changes & Exercise Plan: A diet high in fiber and low in fat can ease menstrual cramps. Fiber helps remove excess pounds around the waist and reduces the risk of constipation. Foods rich in fiber include whole grains, legumes, nuts, seeds, fruits, vegetables, soy products, and dairy products. Low-fat foods are also good choices for those looking to reduce weight. Fatty meats, full-fat cheeses, butter, cream cheese, and margarine are fatty foods that are best avoided due to their high-calorie content. Eating plenty of water and avoiding caffeine and alcohol will keep your stomach well hydrated. Exercising regularly can help increase muscle mass and improve circulation in the pelvis. People who exercise daily report reduced fatigue and fewer menstrual cramps.
Prevention of Dysmenorrhea
Prevention begins with identifying the root cause of the problem. A doctor should be consulted if the cause cannot be determined. Once you identify the cause, prevention includes avoiding certain activities that trigger dysmenorrhea. These activities include heavy lifting, prolonged standing, running, jumping, and strenuous exercise. Other preventative measures include eating foods high in fiber, drinking plenty of water, and getting adequate rest.
- Home Remedies: Home remedies for dysmenorrhea vary from using hot water bottles, warm baths, cold compresses, ice packs, herbal teas, eating foods high in fiber, drinking plenty of fluids, taking over-the-counter medication, and even hormonal therapy.
- Other Considerations: Other considerations include smoking marijuana, alcohol consumption, caffeine intake, poor nutrition, obesity, stress, lack of sleep, dieting, exercise, etc. All these factors can also contribute to the onset of dysmenorrhea.
Complications and risk factors
The following risk factors are associated with developing dysmenorrhea:
- Women who smoke cigarettes are more likely to suffer from chronic pain. Smoking increases levels of nicotine in the body and reduces blood supply to the uterus.
- People who have been pregnant or who have had a hysterectomy (removal of the uterus) are less likely to develop dysmenorrhea. However, these individuals still could have symptoms if their bodies produce abnormal amounts of prostaglandins, hormones that regulate uterine contractions.
- Women who use oral contraceptives containing progestin are five times more likely than those taking non-hormonal methods to experience pelvic pain. Non-progestin oral contraceptive agents do not increase the risk of dysmenorrhea.
- Obesity gives you higher rates of dysmenorrhea and infertility. Fatty foods interfere with digestion, causing food particles to remain in the intestines longer. These undigested particles pass through the intestinal wall and enter the bloodstream. When fatty foods reach the liver, they stimulate the production of triglycerides (a type of fat), leading to increased levels of estrogen and subsequent irritation of the lining of the uterus.
- Inflammatory conditions such as arthritis, asthma, lupus, diabetes, ulcers, celiac sprue, Crohn’s disease, psoriasis, fibromyalgia, allergies, migraines, and diverticulitis are associated with dysmenorrhea. Other conditions that can contribute to inflammation include infections, autoimmune disorders, and cancer.
- Stressful life events such as pregnancy loss, divorce, bereavement, moving away from home, unemployment, relationship problems, financial difficulties, and job promotion or demotion are associated with a greater frequency of dysmenorrhea episodes. A recent study published in Obstetrics & Gynecology showed that having a stressful event during the previous year was related to a three-fold increase in the odds of experiencing dysmenorrhea. These data suggest that psychological stressors may play an important role in the onset of dysmenorrhea, although additional research is needed to confirm this hypothesis.
- Infectious diseases such as chlamydia, gonorrhea, Lyme disease, mononucleosis, syphilis, herpes simplex virus, HIV/AIDS, hepatitis B, and urinary tract infections are associated with greater frequencies of dysmenorrhea attacks.
- Certain genetic traits such as being born female, having parents with similar histories of dysmenorrhea symptoms, and carrying genes that make it easier to become inflamed or irritated may put someone at risk for developing dysmenorrhea.
Final things to keep in mind:
- First thing first – avoid caffeine and alcohol intake while experiencing menstrual cramps. Caffeine increases heart rate and blood pressure, making it harder for the body to regulate its temperature. Alcohol relaxes muscles and reduces muscle tone, further increasing cramping sensations. If you’re going to drink something, opt for water instead.
- Stay away from spicy foods and salty snacks. Spicy food and salt increase stomach acid production, which makes digestion difficult. Avoiding these foods will help alleviate cramps.
- Exercise regularly. Your body requires exercise to function properly. So if you want to get rid of menstrual cramps, make sure you take regular walks or go jogging.
- Reduce stress. Stress is known to trigger menstrual cramps. Try to find ways to relieve stress and stay calm. Meditation, yoga, deep breathing exercises, massage therapy, or listening to soothing music can help.
- Take warm baths. Baths are great for relieving stress and calming your mind. You can also add lavender oil to give yourself a relaxing bath.
- Eat right. A diet rich in fiber and low in sugar and sodium helps to prevent postpartum hemorrhage. Foods you can consume should be rich in iron, vitamin B12, folate, zinc, omega-3 fatty acids, and copper.
- Keep track of your menstrual cycles. Knowing what triggers your cramps can help you plan and prepare accordingly.