SO, a 25 year old lady, was rushed to the hospital with lower abdominal pain of 6 hours’ duration, which was severe enough to prevent her from standing erect. She experiences this severe pain during her monthly menstrual cycle. It has affected her work and her quality of life.
This scenario is quite common amongst young women around the world.
Introduction/Overview: Dysmenorrhea is one of the common causes of pelvic pain in women. It is the commonest gynaecological complaint. It negatively affects patients’ quality of life and sometimes results in activity restriction.
Dysmenorrhea refers to the symptom of painful menstruation. Dysmenorrhea is considered “primary” in the absence of underlying pathology or “Secondary” if it results from specific organic pathology. In older women with no previous history of menstrual cramps, dysmenorrhea is commonly of the secondary type.
Causes: Endometriosis is a common cause of secondary dysmenorrhea. Other causes include; but not limited to; Pelvic inflammatory disease (PID), Ovarian cysts and tumors, Cervical stenosis (narrowing of the passage within the cervix), Adenomyosis, Fibroids, Uterine polyps, and Intrauterine contraceptive device (IUCD).
Risk Factors for Dysmenorrhea (What increases the chances of one person having dysmenorrhea and not the other person?): Having any of the following may increase the likelihood of having dysmenorrhea:
- Heavy menstrual loss
- Positive family history of similar complaint
- Irregular menstrual cycles
- Age younger than 30 years
- Clinically suspected pelvic inflammatory disease
- Sexual abuse
- Having first menstrual flow before 12 years of age
- Low body mass index
- Sterilization (tubal ligation)
- Nulliparity (never had any pregnancy that lasted more than 20weeks)
Diagnosis: No tests are specific to the diagnosis of primary dysmenorrhea. Diagnosis is based on history and physical examination. However, some investigations may be performed to identify or exclude organic causes of secondary dysmenorrhea. These investigations include pelvic or transvaginal scan and blood investigations. Laparoscopy or hysteroscopy may be required, depending on clinical suspicion.
How do we treat/manage Dysmenorrhea?
- Medication is the first-line treatment for relieving dysmenorrhea. Treatment of secondary dysmenorrhea involves correction of the underlying organic cause.
- Pain relievers: Diclofenac, Ibuprofen, Naproxen, Mefenamic acid, etc, are commonly used. They should be taken one to two days before the anticipated onset of menses, and continued for at least three days.
- 28-days Combined Oral Contraceptive Pills have also been found to be useful in primary dysmenorrhea. Combined oral contraceptives are the first-line treatment for dysmenorrhea caused by endometriosis.
- Complementary and Alternative Medicine: Exercise, Omega-3 fatty acid supplement, Thiamine, Pyridoxine (Vitamin B6), Vitamin E, Topical Heat, Low-fat vegetarian diet etc. are alternative remedies with some evidence of efficacy in managing dysmenorrhea.
2. Surgical Therapies: In rare instances, a surgical approach may be considered for women with severe, refractory dysmenorrhea. Refractory dysmenorrhea is an accepted indication for hysterectomy (surgery to remove the uterus).
Key Recommendation: If a woman develops dysmenorrhea many years after the onset of menstrual cycle, it is most likely secondary dysmenorrhea, which means there is a likely underlying cause. There is need to consult a gynaecologist or your family physician for proper evaluation to determine the cause.