Dysmenorrhea (Menstrual Cramps): Causes, Symptoms, Risk Factors, Treatment And Prevention

Dysmenorrhea is the medical term for menstrual cramps. It is characterised by severe or throbbing pain in the lower abdomen. Menstrual cramps are common in all women for a few days before or during the menstrual cycle. Some women feel less pain while for some, it's too severe to handle. The pain often interferes in their day-to-day activities and also cause some health concerns like weakness, diarrhoea and fatigue ^[1] .

Several conditions are responsible for the cause of dysmenorrhea like uterine fibroids and uterine cancer. The pain and bleeding during periods often tend to decrease as women age or after delivering a child.

Types of Dysmenorrhea

Dysmenorrhea is divided into two types which are as follows:

• Primary dysmenorrhea (PD): It is a common form of dysmenorrhea which occurs usually during the adolescence and is marked by normal uterine contraction and not due to some underlying disease. In this type, the pain starts a day before menstruation and lasts for 12-72 hours. Pain due to PD can be felt in the lower section of the abdomen, thighs and hips followed by some symptoms like fatigue and diarrhoea. The pain usually goes away as the woman ages or after the delivery ^[2] .

• Secondary dysmenorrhea (SD): Pain due to SD is caused due to some underlying disorders in the reproductive system of a woman like uterine fibroids, endometriosis, infection, adenomyosis and tumour. The pain begins a few days before menstruation but lasts longer than normal cramps. It is often not accompanied by nausea, fatigue and diarrhoea ^[3] .

Causes Of Dysmenorrhea

Every month, the inner lining of the uterus shred itself when the egg is not fertilized resulting in menstruation. A hormone called prostaglandin controls the contraction and relaxation of the uterus during menstruation. When the hormone rises up in the body due to infection or some underlying disease in women's reproductive organ, painful cramps occur leading to dysmenorrhea ^[4] .

Conditions That Cause Dysmenorrhea

• Uterine fibroids: They are noncancerous tumours of the uterus which often appear during the childbearing age ^[6] .

• Endometriosis: A painful condition in which the tissues that line the uterus, grows outside towards the ovaries, bowel, fallopian tube and on the lining the pelvis ^[7] .

• Adenomyosis: A rare condition characterised by the inner lining of the uterus which breaks through the muscular walls of the uterus ^[3] .

• Pelvic inflammatory disease: It is a bacterial infection caused in the uterus, ovaries, cervix and fallopian tube ^[8] .

• Cervical stenosis: A degenerative condition in which the spinal canal is narrowed resulting in slow menstrual flow and increased pressure inside the uterus ^[9] .

Symptoms Of Dysmenorrhea

Common symptoms of dysmenorrhea include the following. However, it may vary from person to person.

• Intense muscle cramp in the lower abdomen ^[10]
• Severe or continuous pain in the lower abdomen
• Weakness
• Fatigue ^[3]
• Nausea
• Diarrhoea ^[11]
• Pain in the legs and thighs ^[5]

Risk Factors Of Dysmenorrhea

There doesn't need to be a cause behind dysmenorrhea. Some people are just prone to a higher risk of dysmenorrhea. The risk factors are as follows:

• Family history ^[12]
• Smoking ^[13]
• Irregular periods ^[14]
• Early puberty, age 11 ^[1]
• Menorrhagia ^[15]
• Overweight ^[16]
• Women who have never been pregnant before ^[4]

Complications Of Dysmenorrhea

Complications in dysmenorrhea may arise due to late treatment. As aforementioned, several conditions cause dysmenorrhea. When those conditions are not treated on time, some complications may arise. Uterine fibroids can lead to a cancerous tumour, endometriosis can cause infertility or scarring of the uterus, adenomyosis may lead to anaemia in women and pelvic inflammatory disease may lead to serious harm of the uterus ^[17] .

Diagnosis Of Dysmenorrhea

Diagnosis of dysmenorrhea can be done through the following methods:

• Ultrasound: This is done to get a detailed image view of the female reproductive system and find out any disorder.

• Laparoscopy: In this method, a thin incision or cut is made in the abdominal area and laparoscope is inserted which consists of light and camera lens. The method is carried out to find out underlying conditions like ovarian cysts, fibroids and others ^[18] .

• MRI: This is a painless process carried out to get a detailed view of the internal structures of organs.

• Hysteroscopy: In this process, a lighted tube called hysteroscope is inserted into the vagina to look out for any abnormalities in the uterus ^[19] .

Treatment Of Dysmenorrhea

Treatment of dysmenorrhea is carried out after determining the patient's

• age,
• type of menstrual cramp,
• severity of the condition,
• patient's expectation from the course,
• patient's tolerance level for certain drugs or therapies and
• patients preference.

After determining the patient's medical history, the doctor may suggest some lifestyle changes like exercise, balanced diet and adequate sleep. If the patient's condition is severe, they may suggest the following treatment methods:

• Over-the-counter pain relievers: These include pain relievers like ibuprofen and naproxen sodium ^[20] .

• Vitamin supplements: To reduce inflammation and pain during menstrual cramps. They include vitamin D, E and omega-3 fatty acid supplements ^[21] .

• Birth control pills: Oral birth control pills help to reduce the amount of prostaglandins hormone in the body which in turn, reduce cramping and excess blood flow ^[22] .

• Hysterectomy: A process in which the uterus is removed surgically. The process is often carried out in middle or old age women as they are done with their pregnancy and no longer wants to have children ^[23] .

• Endometrial ablation: In this process, endometrium or lining of the uterus is removed by radiofrequency energy to prevent bleeding ^[24] .

Lifestyle Changes To Treat Dysmenorrhea

• Exercise regularly
• Include vitamin E, B1 and B6 in your diet.
• Meditate or do yoga to keep stress under control.
• Quit smoking
• Decrease the quantity of sugar or caffeine in your diet.
• Maintain proper sleeping hours.
• Avoid consuming alcohol during periods.