Dysmenorrhea

Dysmenorrhea is intense pain that occurs during menstruation and may prevent the performance of daily activities.

Symptoms and causesDiagnosisHospitals

Symptoms and causes

Dysmenorrhea is pain experienced before or during menstruation, characterized by cramping in the lower abdomen. These cramps may be accompanied by other symptoms or occur in isolation.

Although it is not a serious condition, dysmenorrhea can interfere with daily activities and lead to work or school absenteeism. Early diagnosis and appropriate treatment reduce discomfort and significantly improve patients’ quality of life.

Symptoms

The characteristic symptoms of dysmenorrhea are:

  • Pelvic pain in the form of cramps that usually begins at the onset of menstruation (in some cases, earlier) and lasts for one or two days. Discomfort is most intense during the first 24 hours.
  • Cramps: painful uterine contractions of varying intensity.

Some women may also experience:

  • Pain radiating to the back or thighs.
  • General malaise.
  • Nausea.
  • Vomiting.
  • Diarrhea or constipation.
  • Headache.
  • Fatigue.
  • Increased urinary frequency (pollakiuria).
  • Abdominal bloating.
  • Heavy menstrual bleeding.
  • Passage of blood clots.

Causes

Menstrual pain is classified into two types depending on its underlying causes:

• Primary dysmenorrhea: menstrual cramps occur from the first menstrual periods and are not associated with an underlying pathology. The pain is believed to result from the effect of prostaglandins, hormone-like molecules that promote vasoconstriction and uterine contractions necessary to expel the endometrium (the mucosal tissue that thickens monthly in the uterus to accommodate a potential embryo).

• Secondary dysmenorrhea: pain is the result of a specific disease or condition:

  • Endometriosis: growth of uterine lining tissue outside the uterus.
  • Uterine polyps: benign solid tissue growths protruding from the endometrium.
  • Uterine fibroids: benign tumors composed of uterine muscle tissue.
  • Ovarian cysts: fluid-filled sacs that form in the ovary. They are usually benign and resolve spontaneously.
  • Uterine adhesions: formation of bands of scar tissue that bind the uterine walls and damage the endometrium. They are often the result of infections or medical procedures, such as curettage or cesarean section.
  • Sexually transmitted infections (STIs): bacterial, viral, or parasitic infections transmitted through sexual contact.
  • Pelvic inflammatory disease: infection of the female reproductive organs (uterus, ovaries, or fallopian tubes) resulting from an STI.
  • Emotional disorders: chronic stress, anxiety, or depression can cause hormonal imbalance, increasing pain perception.
  • Abnormal uterine position and angle: when the uterus is not positioned normally, it may cause menstrual pain.

▪ Retroversion: the uterus tilts backward (toward the rectum) instead of forward.
▪ Anteflexion: marked forward angulation of the uterine body, which tilts over the bladder.
▪ Retroflexion: extreme backward angulation of the uterine body while the cervix remains in its normal position.

  • Intrauterine device (IUD): a contraceptive method placed in the uterus. It may prevent pregnancy through hormone release or by using a copper device that immobilizes sperm. In some cases, copper increases prostaglandin production, leading to uterine contractions.

Risk Factors

Factors that increase the risk of dysmenorrhea include:

  • Early menarche: onset of menstruation between ages 9 and 11.
  • Long menstrual periods: bleeding lasting more than 7–8 days.
  • Heavy menstrual bleeding.
  • Nulliparity: not having given birth or not having had a pregnancy beyond 20 weeks.
  • Age: more common in women under 30 years.
  • Smoking: tobacco use causes systemic inflammation, increasing prostaglandin production.Excessive alcohol consumption: dehydration increases the sensation of discomfort.
  • Family history of menstrual pain: some conditions causing dysmenorrhea, such as endometriosis, uterine fibroids, or elevated prostaglandin levels, have a genetic predisposition.

Complications

The most frequent complications of dysmenorrhea are:

  • Chronic pelvic pain.
  • Reduced academic or work performance.
  • Social isolation.
  • Irritability.

What specialist treats dysmenorrhea?

Dysmenorrhea is managed within the specialty of Gynecology and Obstetrics.

Diagnosis

Dysmenorrhea is diagnosed based on the symptoms reported by the patient. To determine its severity and underlying cause, several complementary tests are performed:

• Pelvic examination: evaluation of the vulva, vagina, cervix, ovaries, and uterus. It includes several stages:

  • External visual examination to detect color changes, sores, inflammation, or irritation.
  • Internal visual examination: using a speculum to open the vagina and assess the vagina and cervix.
  • Pelvic palpation: the abdominal area is palpated with one hand while two lubricated, gloved fingers of the other hand are inserted into the vagina. This procedure allows assessment of the shape and size of the uterus and ovaries, as well as detection of possible masses.

• STI testing: a urine sample is collected and analyzed in the laboratory to detect pathogen DNA associated with sexually transmitted infections.

• Pelvic ultrasound: ultrasound imaging is used to obtain real-time images of the uterus, ovaries, and fallopian tubes. This procedure may be abdominal—where the probe is moved over the abdomen—or transvaginal—where the probe is inserted into the vagina to obtain more detailed images.

Treatment

The initial treatment for dysmenorrhea consists of medications to relieve pain. The most effective are prostaglandin inhibitors, such as nonsteroidal anti-inflammatory drugs (NSAIDs). It is recommended to begin taking them at the first signs of pain and continue until the second day of the menstrual cycle.

In cases of primary dysmenorrhea where pain does not improve with medication, hormonal contraceptives are prescribed. These contraceptives inhibit ovulation and thin the endometrium, resulting in reduced inflammation, decreased bleeding, and lower prostaglandin levels.

Applying heat to the abdomen and engaging in mild exercise may also be beneficial.

Secondary dysmenorrhea usually resolves when appropriate treatment is provided for the underlying condition.

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