Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe uterine pain during menstruation. While many individuals experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or require medication.
Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.
Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these are detected.
During a woman's menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is thus not needed.
Molecular compounds called prostaglandins are released. These compounds cause the muscles of the uterus to contract. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions are responsible for the varying degrees of pain and discomfort commonly experienced during menstruation.
Research indicates that one mechanism underlying dysmenorrhea is a disturbed balance between antiinflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor eicosanoids derived from omega-6 fatty acids. Several studies have indicated that intake of omega-3 fatty acids can reverse the symptoms of dysmenorrhea, by decreasing the amount of omega-6 FA in cell membranes. The richest dietary source of omega-3 fatty acids is found in flax oil.
Oral intake of magnesium has also been indicated in providing relief: two double-blind, placebo-controlled studies demonstrated a positive therapeutic effect of magnesium on dysmenorrhea. A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss. A review of case histories indicated that zinc, in 1 to 3 30-milligram doses given daily for one to four days prior to onset of menses, prevents essentially all to all warning of menses and all menstrual cramping. Intake of thiamine (vitamin B1) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.
Behavioral therapies assume that the physiological process underlying dysmenorrhea is influenced by environmental and psychological factors, and that dysmenorrhea can be effectively treated by physical and cognitive procedures that focus on coping strategies for the symptoms rather than on changes to the underlying processes. A 2007 systematic review found some scientific evidence that behavioral interventions may be effective, but that the results should be viewed with caution due to poor quality of the data.
Acupuncture and acupressure are used to treat dysmenorrhea. A review cited four studies, two of which were patient-blind, indicating that acupuncture and acupressure were effective. This review stated that the treatments appear "promising" for dysmenorrhea, and that the researchers considered further studies to be justified. Another study indicated that acupuncture "reduced the subjective perception of dysmenorrhea", still another indicated that adding acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life.
Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms, a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.
Treatment with a transcutaneous electrical nerve stimulation (TENS) unit, often used for chronic pain, was indicated as effective in several studies. One study encouraged providers to try the TENS unit with patients, on the grounds that they found it to be "non-invasive, efficient, and easy to use". A study led by the same researchers reported proof of TENS' effectiveness.
Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis. Other causes include leiomyoma, adenomyosis, ovarian cysts, and pelvic congestions. The presence of a copper IUD can also cause dysmenorrhea. In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was observed to provide relief.
Report finds newer not necessarily better for treating dysmenorrhea.(mefenamic acid (nonsteroidal anti-inflammatory drug) for the treatment of dysmenorrhea)
Aug 29, 2002; 2002 AUG 29 - (NewsRx.com & NewsRx.net) -- A review article published in the July 2002 issue of OBG Management found that newer...