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10 February, 2010

Home > Fact sheets by category > Diseases and conditions > Reproductive system > Menstruation > Menstruation - dysmenorrhoea.

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Menstruation - dysmenorrhoea

Dysmenorrhoea means painful periods. Normal menstruation that happens to be painful is known as primary dysmenorrhoea, while secondary dysmenorrhoea refers to period pain caused by certain reproductive disorders, such as endometriosis. In primary dysmenorrhoea, it is thought that the muscles of the uterus squeeze and contract harder than normal to dislodge the thickened lining. These contractions may also hamper blood flow to the uterus, exacerbating the pain. Women of any age can experience painful periods and some women find that periods are no longer painful after pregnancy and childbirth.

Symptoms
Symptoms of dysmenorrhoea can include:

Pain low in the abdomen. The pain may spread to include the lower back and legs.
Pain which is gripping, or experienced as a constant ache, or in combination.
Typically, the pain commences on or before the start of the menstrual period.
The first 24 hours is the most painful.
Clots are passed in the menstrual blood.

Sometimes, dysmenorrhoea is associated with:

Headache.
Nausea and vomiting.
Digestive upsets, such as diarrhoea or constipation.
Fainting.
Premenstrual symptoms, such as tender breasts and swollen abdomen, which may continue throughout the period.
Pain beyond the first 24 hours. The pain tends to subside after two or three days.

The trigger of primary dysmenorrhoea is mysterious
In primary dysmenorrhoea, the uterus works too hard to dislodge its lining (endometrium) and the resulting contractions and associated ischaemia (hampered blood flow) cause pain. The hormone-like compounds that prompt these uterine contractions are prostaglandins. It seems that a woman with dysmenorrhoea has comparatively high levels of prostaglandins, which cause harder than normal uterine contractions. The reasons for the increased prostaglandins are unknown.

Treatment for primary dysmenorrhoea
A woman with dysmenorrhoea needs a thorough medical examination to ensure that her period pain isn’t caused by some kind of reproductive disease, such as endometriosis. Treatment options for primary dysmenorrhoea include:

Bed rest during the first day or so of the menstrual period.
Heat treatment, such as hot water bottles held across the abdomen.
Pain-killing drugs, such as paracetamol.
Drugs that inhibit prostaglandins, such as ibuprofen.
Regular exercise and attention to overall physical fitness.
Relaxation techniques.
The oral combined contraceptive pill, which usually eliminates period pain by suppressing ovulation.

Secondary dysmenorrhoea
Some of the causes of secondary dysmenorrhoea include:

Endometriosis - the cells that line the uterus migrate to other areas of the pelvis, causing severe pain on menstruation.
Fibroids - benign tumours made of muscle and tissue, which grow inside the uterus and are thought to be influenced by the sex hormone oestrogen.

Treatment for secondary dysmenorrhoea
Treatment depends on the cause, but may include:

Medications - such as anti-inflammatories or the oral combined contraceptive pill.
Surgery - is occasionally used to treat fibroids or endometriosis.

Where to get help

Your doctor
Family planning clinic
Gynaecologist.

Things to remember

Dysmenorrhoea means painful periods.
Normal menstruation that happens to be painful is known as primary dysmenorrhoea, while secondary dysmenorrhoea refers to period pain caused by certain reproductive disorders.
Treatment options include hormone replacement therapy, pain-killing drugs and surgery.

You might also be interested in:
Endometriosis.
Fibroids.
Menstrual cycle.
Menstruation - amenorrhoea.
Menstruation - athletic amenorrhoea.
Ovulation.
Ovulation pain.
Premenstrual syndrome.
Premenstrual syndrome - treatment options.
Reproductive system.
Vaginal bleeding - irregular.

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