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Microsoft word - dysmenorrhea.doc


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Dysmenorrhea

Many women experience pain and cramps that occur with menstruation. For some women, this pain is severe
and limits normal activities.
Symptoms
Symptoms that may be present include abdominal pain, cramping, low back pain or pain radiating down the
upper legs. Usually the severe pain begins with the onset of a period and lessens over the next 12 to 72 hours
Primary dysmenorrhea: Severe menstrual pain begins within the first couple of years of menstruation.
The uterine lining naturally produces prostaglandins, which are chemicals that cause the muscle of the
uterus to contract. Women with dysmenorrhea may produce more prostaglandins which results in
abnormally strong uterine contractions. Primary dysmenorrhea usually lessens with time, particularly
after childbirth.
Secondary dysmenorrhea: Onset of severe pain begins years after the onset of periods and is related
to a physical cause.
Fibroids, benign muscle tumors of the uterus Endometriosis, tissue from the lining of the uterus growing in abnormal locations outside of the uterus Pelvic infections Adenomyosis, growth of the endometrium into the muscle wall of the uterus
Diagnosis
History and pelvic exam are required. Additional tests that may be ordered include cultures and a pelvic
ultrasound. A diagnostic laparoscopy is used to assist in making a diagnosis for the cause of the pain.
Treatment
• Heat applied to the lower abdomen or back can be soothing. • Exercising regularly will decrease dysmenorrhea. Aerobic exercise produces chemicals that block pain. • NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen, naproxen, and mefenamic acid may provide pain relief and also decrease prostaglandin production when taken early (even the day before the period starts). If the medications that are available over the counter do not provide enough relief, a prescription medication from your provider may be necessary. Women with ulcers, bleeding disorders, or liver dysfunction should not use NSAIDs. • Birth Control Pills, Depoprovera, and the Mirena IUD will generally decrease the severity of menstrual pain. By preventing ovulation (the release of an egg) with pills or the Depoprovera, the lining of the uterus stays thin and decreases prostaglandin release. Depoprovera and Mirena IUD’s contain progestin hormones that eliminate or decrease the occurrence of periods and therefore eliminate the associated pain. Under your provider’s guidance, birth control pills (oral contraceptives) can also be safely used to extend the time between periods (for example, every three months), or to stop periods from coming at all. • Surgery may provide relief if symptoms are unable to be controlled with medications. Surgery is focused on treating the cause of the pain. For example, laparoscopy is frequently used for diagnosis and treatment of endometriosis. Removal of fibroids may be done by laparoscopy, robot-assisted laparoscopy, or laparotomy. Hysterectomy may also be an option if fertility is no longer desired. Nguyen N. Giep, M.D. . Ann J. Kelly, M.D. . Bang N. Giep, M.D. . Peter A. Sereque, M.D. . Hoang N. Giep, M.D. . N. Dawn Bingham, M.D. . Ashley R. Fowler, M.D.

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