Painful menstruation is termed dysmenorrhea. It is a common issue for women in their reproductive years and can range from mild pelvic cramping to severe pain interfering with daily activities such as school or work. The pain is usually sharp intermittent cramping in the midline of the pelvis starting around the start of a period typically lasting 1-3 days. There may also be associated symptoms of nausea, vomiting, diarrhea, headache, and backache.
Primary dysmenorrhea occurs during menstruation when the inner lining of the uterus, or endometrium is shed and releases hormones called prostaglandins. These prostaglandins induce painful uterine contractions.
Secondary dysmenorrhea occurs when painful menstrual cramps are due to another physical issue outside of menstruation such as the following:
The evaluation for dysmenorrhea is centered on ruling out the causes of secondary dysmenorrhea. Primary dysmenorrhea does not involve any changes on exam, labs or imaging.
Primary dysmenorrhea is treated with over-the-counter nonsteroidal anti-inflammatory medications such as Advil or Motrin. A heating pad is often used to help ease pain symptoms. Contraception such as oral contraceptives, NuvaRing or an intrauterine device may also resolve heavy bleeding and cramping pain.
Secondary dysmenorrhea treatment depends on the exact cause. Oral or intravenous antibiotic treatment is used in cases of PID. Medical and surgical options exist for endometriosis, fibroids, ovarian cysts and adenomyosis. Medical treatment is aimed at symptom control. Surgical options such as laparoscopy or robotic assisted laparoscopy can be minimally invasive methods utilized to obtain a diagnosis as well as treat the primary condition.
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