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Dysmenorrhea; symptoms, diagnosis, home remedies and medical treatments.

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Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods.
For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities for a few days every month.
Menstrual cramps may be caused by identifiable problems, such as endometriosis or uterine fibroids. Treating any underlying cause is key to reducing the pain. Menstrual cramps that aren't caused by an underlying condition tend to lessen with age and often improve once a woman has given birth.

SYMPTOMS

Symptoms of menstrual cramps include:
  • Throbbing or cramping pain in your lower abdomen that may be intense
  • Dull, constant ache
  • Pain that radiates to your lower back and thighs
Some women also experience:

When to see a doctor

If you've started menstruating within the past few years and have menstrual cramps, chances are your menstrual pain isn't a cause for concern. However, if menstrual cramps disrupt your life every month, if your symptoms progressively worsen, or if you're older than 25 and just started having severe menstrual cramps, see your doctor.

CAUSES

During your menstrual period, your uterus contracts to help expel its lining. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more-severe menstrual cramps.
Severe contractions may constrict the blood vessels feeding the uterus. The resulting pain can be compared to the chest pain that occurs when blocked blood vessels starve portions of the heart of food and oxygen.
Menstrual cramps may also be caused by:
  • Endometriosis. In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.
  • Uterine fibroids. These noncancerous growths in the wall of the uterus may be the cause of pain.
  • Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.
  • Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
  • Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.

RISK FACTORS

You may be at greater risk of menstrual cramps if:
  • You're younger than age 30
  • You started puberty early, at age 11 or younger
  • You have heavy bleeding during periods (menorrhagia)
  • You have irregular menstrual bleeding (metrorrhagia)
  • You've never given birth
  • You have a family history of dysmenorrhea
  • You're a smoker

COMPLICATIONS

Menstrual cramps don't cause any other medical complications, but they can interfere with school, work and social activities.
Certain conditions associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).

PREPARING FOR YOUR APPOINTMENT

For menstrual cramps, you may start by seeing your primary physician or a doctor who specializes in the female reproductive system (gynecologist). Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

You may want to make note of:
  • How severe your symptoms are and when your cramps first started
  • The dates when your last two menstrual periods began
  • Information about medical problems you've had
  • Information about the medical problems of your parents or siblings
  • All the medications and dietary supplements you take
  • Questions to ask your doctor
Preparing a list of questions ahead of time can help you make the most of your time with your doctor. For menstrual cramps, some basic questions to ask include:
  • What's the most likely cause of my symptoms?
  • Are my symptoms likely to change over time?
  • Do I need any tests?
  • What treatments or home remedies might help?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?
Don't hesitate to ask additional questions that occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:
  • How old were you when you first began menstruating?
  • How far apart are your menstrual periods, and how long do they typically last?
  • How heavy is your menstrual bleeding? Do you ever bleed between periods?
  • Where are your cramps located?
  • Do you have any other symptoms, such as nausea, vomiting, diarrhea, back pain, dizziness or headache?
  • Do your symptoms typically occur along with your period? Or at other times?
  • Do your symptoms cause you to limit your activities, stay home from work or school, or avoid exercise?
  • If you're sexually active, do you experience pain with intercourse?
  • What treatments have you tried so far, if any? Has anything helped?
  • Do any of the women in your family have a history of similar symptoms?

What you can do in the meantime

You may find relief from menstrual cramps by taking a warm bath or applying a heating pad, hot water bottle or heat patch to your abdomen. Over-the-counter pain relievers, such as ibuprofen, also may help.

TESTS AND DIAGNOSIS

Your doctor will review your medical history and perform a physical exam, including a pelvic exam. During the pelvic exam, your doctor will check for any abnormalities in your reproductive organs and look for signs of infection.
If your doctor suspects that your menstrual cramps are being caused by an underlying disorder, he or she may recommend other tests, such as:
  • Ultrasound. This test uses sound waves to create an image of your uterus, cervix, fallopian tubes and ovaries.
  • Other imaging tests. A CT scan or magnetic resonance imaging (MRI) provides more detail than an ultrasound and can help your doctor diagnose underlying conditions. A CT scan combines X-ray images taken from many angles to produce cross-sectional images of bones, organs and other soft tissues inside your body.
    MRI uses radio waves and a powerful magnetic field to produce detailed images of internal structures. Both tests are noninvasive and painless.
  • Laparoscopy. Laparoscopy usually isn't necessary for the diagnosis of menstrual cramps, but it can help detect an underlying condition, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy. During this outpatient surgery, your doctor views your abdominal cavity and reproductive organs by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens.

TREATMENTS AND DRUGS

Menstrual cramps are treatable. Your doctor may recommend:
  • Pain relievers. Your doctor may suggest taking over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), at regular doses starting the day before you expect your period to begin. Prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as mefenamic acid (Ponstel), also are available. If you can't take NSAIDs, acetaminophen (Tylenol, others) may lessen your pain.
    Start taking the pain reliever at the beginning of your period, or as soon as you feel symptoms, and continue taking the medicine as directed for two to three days, or until your symptoms have gone away.
  • Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm, a flexible ring that you insert into your vagina, or an intrauterine device (IUD).
  • Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, surgery to correct the problem may help reduce your symptoms. Surgical removal of the uterus also may be an option if you're not planning to have children.

LIFESTYLE AND HOME REMEDIES

Things you may want to try at home include:
  • Exercise. Studies have found that physical activity may ease the pain of menstrual cramps.
  • Heat. Soaking in a hot bath or using a heating pad, hot water bottle or heat patch on your lower abdomen may ease menstrual cramps. 
  • heat may be just as effective as over-the-counter pain medication for relieving menstrual cramps.
  • Dietary supplements. A number of studies have indicated that vitamin E, omega-3 fatty acids, vitamin B-1 (thiamine), vitamin B-6 and magnesium supplements may effectively reduce menstrual cramps.
  • Avoiding alcohol and tobacco. These substances can make menstrual cramps worse.
  • Reducing stress. Psychological stress may increase your risk of menstrual cramps and their severity.

ALTERNATIVE MEDICINE

Most alternative therapies haven't been well-studied for treating menstrual cramps and need further study before experts can clearly recommend one treatment or another. However, some alternative treatments may help with menstrual cramps, including:
  • Acupuncture. Acupuncture involves inserting extremely thin needles through your skin at strategic points on your body. Some studies have found that acupuncture helps relieve menstrual cramps.
  • Transcutaneous electrical nerve stimulation (TENS). A TENS device connects to the skin using adhesive patches with electrodes in them. The electrodes deliver a varying level of electric current to stimulate nerves.
    TENS may work by raising the threshold for pain signals and stimulating the release of endorphins, your body's natural painkillers. In studies, TENS was more effective than a placebo in relieving menstrual cramp pain.
  • Herbal medicine. Some herbal products, such as pycnogenol, fennel or combination products, may provide some relief from menstrual cramps.
  • Acupressure. Like acupuncture, acupressure also involves stimulating certain points on the body. In acupressure, this is done with gentle pressure on the skin instead of needles. Although research on acupressure and menstrual cramps is limited, it appears that acupressure may be more effective than a placebo in easing menstrual cramps.

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