• Increased prostaglandins and arachidonic. Considered as the chief cause, these chemicals induce uterine-muscle (myometrium) contractions.

• Abnormal nervous-system response. The autonomic nervous system (ANS) contains the pain receptors in nerve fibers in the uterus and pelvic area and women with really sensitive or ANS abnormalities may have a more intense response to pain.

• Obstructive factor or a narrowed or constricted cervix.

• Psychological factors.

• Genetic factors. Regulating a number of enzymes, genetic factors are associated with recurrent primary dysmenorrhea. They may play a critical role in over half the cases.

    In secondary dysmenorrhea, the pain is due to pelvic pathology or other medical conditions like lesions. The most common of these is endometriosis, especially if dysmenorrhea begins after 20. Other causes include pelvic infections or pelvic inflammatory disease (PID), uterine fibroids or benign tumors, adenomyosis, miscarriage, ectopic pregnancy, uterine polyps, use of intrauterine device (IUD), and congenital abnormality. About half of menstruating women experience primary dysmenorrhea.

    Primary dysmenorrhea usually sets in within a year or two years after the first menstruation. The pain typically develops when the bleeding starts and continues for 32 to 48 hours. On the other hand, secondary dysmenorrhea usually occurs after a woman has had menstrual periods for some time and the pain often lasts longer than the menses. It may also occur outside of the menstrual period.

Is dysmenorrhea treatable?

    Initial treatment of severe menstrual cramps aims to relieve the pain while long-term goals of treatment involves treating the underlying cause, which may be done in various ways.

    Diet. A well-balanced diet is highly recommended. This includes lots of whole grains, fruits, and vegetables, avoiding saturated fats and junk foods. Dietary adjustments starting about 14 days prior to menstruation may help. The following recommendations are results of studies.

    Low-fat, high-fish diets. A Low-fat vegetarian diet taken during cycles may result in less pain and bloating than a meat-based diet. An alternative for meat is fish and egg. Less pain is also associated with higher intake of omega-3 fatty acids (found in oily fish like salmon and tuna). Fish-oil supplements also appear to reduce heavy bleeding.

    Adequate fluid intake. Take two quarts of water every day.

    Vitamins and minerals. Vitamin B1 (thiamin) found abundantly in pork and other sources like fortified cereals, oatmeal, and sunflower seeds help relieve cramps. In a study, women took 100 mg daily. Vitamin B6, 50 to 100 mg/day, and magnesium-rich food may also be helpful.

    Reduce caffeine, sugar, and alcohol. According to studies, smokers are 50-percent more at risk for menstrual pain. Alcohol consumption during menstruation may prolong the pain.

    Low sodium. Salt attracts water and excessive water results in bloating, which is associated with premenstrual syndrome (PMS) that frequently accompanies dysmenorrhea.

    Exercise. Although it is not clear how intense the exercise should be, regular and vigorous exercise reduces discomfort of future periods. For example, aerobic exercise 30 minutes a day, three times a week can help.

    Sexual activity. Reports say that orgasm reduces the severity of menstrual cramps.

    Heat Application. Heat relieves pain. Applying a heating pad to the lower abdomen or back may be as effective as taking ibuprofen. Take warm baths or sit in a tub of hot water for 10 to 15 minutes as often as necessary.

    Medication. What if menstrual cramps are not relieved ordinarily and becomes intolerable at some point during the periods? Certain drugs could then be prescribed by a physician. In this case, medication is aimed at decreasing prostaglandin production and hormonal alteration.

    Nonsteroidal antiinflammatory drugs (NSAIDs). Aspirin, ibuprofen, or naproxen sodium and mefenamic acid or similar stronger drugs block prostaglandins and also act against imflammatory factors that may be responsible for heavy menstrual bleeding. Generally well tolerated, these drugs are best taken with the onset of menstruation or three to seven days before a period is expected. Tylenol may be less effective than other NSAIDs but it has less harmful effects on the gastrointestinal tract.

    Hormonal therapies. Hormonal contraception prevents ovulation and decreases the thickness of the uterine lining resulting in lesser prostaglandin production. Oral contraceptives contain combinations of estrogen and progestin and these are generally taken for 21 days with a seven-day break for menstruation.

    Progestin alone (without the combination of estrogen) may also be taken to avoid the more serious side effects. It is effective in reducing pain from severe cramps.

    GnRH agonists. Gonadotropin-releasing hormone (GnRH) agonists stop ovary function. They reduce or suppress estrogen levels (and therefore menstruation).

    Synthetic male hormone. Danazol, a synthetic drug, is similar to the male hormone. It suppresses estrogen and is used to treat dysmenorrhea.

    NSAIDs, hormone contraceptives, and other drugs have specific side effects and contraindications that need to be considered.

    According to obstetrician-gynecologist Milagros Jocson, consultant at The Medical City, the treatment of dysmenorrhea will essentially depend on its type. Management in secondary dysmenorrhea extends to identifying the pathologic cause and treating it appropriately. Mistaking secondary dysmenorrhea for primary cramps will prolong the symptom and contribute to the progression of any underlying cause of pain. A patient who walks into her clinic complaining of dysmenorrhea will be evaluated by such tests as pelvic exam or transvaginal or transrectal ultrasound to be sure.

    Besides diet, exercise, heat, pain-relieving and hormonal medications, certain alternative techniques have also been tried to relieve discomfort from dysmenorrhea.

• Acupuncture, acupressure, or reflexology. Small pins or pressure applied on various pressure points of the body relieve pain in the pelvic area. These Oriental techniques stimulate nerve receptors that interact with pain blockers in the brain.

• Chiropractic or spinal manipulation promotes relaxation and was studied to relieve pain.

• Yoga and meditation techniques also promote general relaxation.

• Hypnosis.

• Psychotherapy may be initiated if dysmenorrhea is stress-related.

• Transcutaneous electrical nerve stimulation (TENS) involves placing electrodes in certain parts of the body and administering low-level electrical pulses that subsequently alter the body's ability to receive pain signals.

    A radical approach for severe primary dysmenorrhea involves surgically destroying the pain-conducting nerve fibers leading from the uterus. Uterine nerve ablation and laparoscopic presacral neurectomy block these nerves that transmit pain to the lower back. These procedures are done as a last resort.

    Dysmenorrhea is the most common gynecologic problem among women and can be incapacitating, disrupting activities each month. Does the pain ever go away? There are cases when there is reduction of pain after childbirth. Some women outgrow the pain while others experience even more severe pain at some later age, and as previously mentioned the underlying cause of this pain will have to be studied carefully to determine the appropriate medical or surgical treatment.

 

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