dysmenorrhea

Definition

Dysmenorrhea is the occurrance of painful cramps during menstruation.

Description

More than half of all girls and women suffer from dysmenorrhea (cramps), a dull or throbbing pain that usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps.

While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month.

— Carol A. Turkington

[New Latin : DYS- + Greek mēn, month + -RRHEA.]

For more information on dysmenorrhea, visit Britannica.com.

Pain during menstruation. There are many possible causes including reduced blood supply to the uterus and psychological factors. Dysmenorrhoea is less common in physically active women. See also amenorrhoea and menstruation.

Painful menstruation.

Definition

Dysmenorrhea is the occurrence of painful cramps during menstruation.

Description

More than half of all girls and women suffer from dysmenorrhea (cramps), a dull or throbbing pain that usually centers in the lower mid-abdomen, radiating toward the lower back or thighs. Menstruating women of any age can experience cramps.

While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month. In fact, about 43 % of women in the United States suffer pain so severe that it disrupts their daily lives and about 18% miss one or more days or work, school, or other activities each year because of menstrual cramps.

Causes & Symptoms

Dysmenorrhea is called "primary" when there is no specific abnormality, and "secondary" when the pain is caused by an underlying gynecological problem. It is believed that primary dysmenorrhea occurs when prostaglandins, hormone-like substances produced by uterine tissue, trigger strong muscle contractions in the uterus during menstruation. However, the level of prostaglandins does not seem to correlate with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts assume that cramps must also be related to other causes, such as diets, genetics, stress, and different body types, in addition to prostaglandins. The first year or two of a girl's periods are not usually very painful. However, once ovulation begins, the blood levels of the prostaglandins rise, leading to stronger contractions.

Secondary dysmenorrhea may be caused by endometriosis, fibroid tumors, or an infection in the pelvis.

The likelihood that a woman will have cramps increases if she:

• has a family history of painful periods
• leads a stressful life
• doesn't get enough exercise
• uses caffeine
• has pelvic inflammatory disease (PID)

Symptoms include a dull, throbbing cramping in the lower abdomen that may radiate to the lower back and thighs. In addition, some women may experience nausea and vomiting, diarrhea, irritability, sweating, or dizziness. Cramps usually last for two or three days at the beginning of each menstrual period. Many women often notice their painful periods disappear after they have their first child, probably due to the stretching of the opening of the uterus or because the birth improves the uterine blood supply and muscle activity, although others do not notice a change.

Diagnosis

A doctor should perform a thorough pelvic exam and take a patient history to rule out any underlying condition that could cause cramps.

Treatment

Nutritional Therapy

The following dietary changes may help prevent or treat menstrual pain:

• Increased dietary intake of foods such as fiber, calcium, soy foods, fruits and vegetables.
• Decreased consumption of foods that exacerbate PMS. They include caffeine, salt and sugar.
• Quitting smoking. Smoking has been found to worsen cramps.
• Taking daily multi-vitamin and mineral supplements that contain high doses of magnesium and vitamin B₆ (pyridoxine), and flaxseed or fish oil supplements. Recent research suggests that vitamin B supplements, primarily vitamin B₆ in complex, magnesium, calcium, zinc, vitamin E, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.

Herbal Therapy

An herbalist may recommend one of the following herbal remedies for menstrual pain:

• Chasteberry (Vitex agnus-castus) for women who also experience breast pain, irregular periods, and ovarian cysts.
• Dong quai (Angelica sinensis) for women with typical menstrual pain.
• Licorice (Glycyrrhiza glabra) for abdominal bloating and cramping.
• Black cohosh (Cimifuga racemosa) for relief of menstrual pain as well as mood swing and depression.

Yoga

Several yoga positions are popular as methods to ease menstrual pain. In the "cat stretch" position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies with knees bent, and then lifts the pelvis and buttocks.

Exercise

Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers.

Other Remedies

Acupuncture and Chinese herbs are other popular alternative treatments for cramps. There are particular formulas depending on the pattern of imbalance. Aromatherapy and massage may ease pain for some women. Transcutaneous Electrical Nerve Stimulation (TENS) has been touted as a safe and practical way to relieve the pain of dysmenorrhea. It works by using electrodes to stimulate nerve fibers. Some women find relief through visualization, concentrating on the pain as a particular color and gaining control of the sensations. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods. Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position with knee pulled up to the chest while hugging a heating pad or pillow to the abdomen. Also, orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.

Allopathic Treatment

Several drugs can lessen or completely eliminate the pain of primary dysmenorrhea. Most popular are the non-steroidal anti-inflammatory drugs (NSAIDs), which prevent or decrease the formation of prostaglandins. These include aspirin, ibuprofen (Advil), and naproxen (Aleve). For more severe pain, prescription strength ibuprofen (Motrin) is available. These drugs are usually begun at the first sign of the period and taken for a day or two.

If an NSAID is not available, acetaminophen (Tylenol) may also help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help.

Studies of a drug patch containing glyceryl trinitrate to treat dysmenorrhea suggest that it also may help ease pain. This drug has been used in the past to ease preterm contractions in pregnant women.

In 2002, an intrauterine device (IUD) was introduced to help eliminate the pain of menstrual cramps related to endometriosis. The IUD, known as Mirena, is approved for use in the Untied States as a contraceptive.

Expected Results

Treatments should lessen or eliminate pain.

Prevention

Avoidance of caffeine, alcohol, and sugar prior to onset of period and NSAIDs taken a day before the period begins should eliminate cramps for some women.

Resources

Books

Carlson, Karen J., Stephanie Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.

Murray, Michael T and Joseph E. Pizzorno. "Premenstrual syndrome." In Encyclopedia of Natural Medicine. Rev. 2nd ed. Rocklin, CA: Prima Publishing, 1998.

Periodicals

Hale, Ellen. "Taming menstrual cramps." FDA Consumer 25, no. 5 (June 1991): 26–29.

Harel, Z., et.al. "Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents." American Journal of Obstetrics and Gynecology 174 (April 1996): 13, 335–8.

McDonald, Claire, and Susan McDonald. "A Woman's Guide to Self-care." Natural Health (January–February 1998): 121–142.

"Menstrual Pain Severely Affects almost Half of U.S. Women." AORN Journal (April 2002): 121–778.

"More Power, Less Pain." Chemist & Druggist (April 6, 2002): 36.

"The Mirena IUD May Diminish Endometriosis –related Dysmenorrhea (Results of Two Small Studies)." OB GYN News (May 15 2002): 16.

Organizations

American College of Obstetricians and Gynecologists. 409 12th St. SW, Washington, DC 20024. (202) 638-5577.

Federation of Feminist Women's Health Centers. 633 East 11th Ave., Eugene, OR 97401. (503) 344-0966.

National Women's Health Network. 1325 G St. NW, Washington, DC 20005. (202) 347-1140.

[Article by: Katy Nelson, N.D.]

Definition

Dysmenorrhea refers to the pain or discomfort associated with menstruation. Although not a serious medical problem, the term describes a woman adolescent girl with menstrual symptoms severe enough to keep her from functioning for a day or two each month.

Description

Menstrual cramps are a common problem for adolescent girls and women. They may be mild, moderate, or severe and are the single most common cause of days missed from school and work. About 10 percent of girls are incapacitated for up to three days each month. Although many teens do not suffer from dysmenorrhea because their uterus is still growing, they may get it several years after their first period begins. The symptoms may begin one to two days before menses, peak on the first day of flow, and subside during that day or over several days.

Causes and Symptoms

Primary dysmenorrhea is the more common type of dysmenorrhea and is due to the production of prostaglandins. Prostaglandins are natural substances made by cells in the inner lining of the uterus and other parts of the body. Those made in the uterus make the uterine muscles contract and help the uterus to shed the lining that has built up during the menstrual cycle. It appears, however, that the level of prostaglandins has nothing to do with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. Thus cramps must also be related to something other than prostaglandins, such as genetics, stress, and different body types. The first year or two of a girl's periods are not usually very painful; however, once ovulation begins, the blood levels of the prostaglandins rise, leading to stronger contractions during menstruation. Prostaglandins can also cause headaches, nausea, vomiting, and diarrhea. The likelihood that a woman will have cramps increases if the following apply to her:

• She has a family history of painful periods.
• She leads a stressful life.
• She does not get enough exercise.
• She uses caffeine.
• She has pelvic inflammatory disease.

Primary dysmenorrhea usually presents during adolescence, within three years of menarche. It is unusual for symptoms to start within the first six months after menarche. Affected young women experience sharp, intermittent spasms of pain, usually centered in the suprapubic area. Pain may radiate to the back of the legs or the lower back. Systemic symptoms of nausea, vomiting, diarrhea, fatigue, fever, headache, or lightheadedness are fairly common. Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle. Some women notice that painful periods disappear after having their first child. This could be due to the stretching of the opening of the uterus or the fact that birth improves the uterine blood supply and muscle activity.

Secondary dysmenorrhea is defined as menstrual pain due to pelvic pathology. This condition usually occurs after a woman has had normal menstrual periods for some time. It differs from primary dysmenorrheal in that the pain is caused by an abnormality or disease of the uterus, tubes, or ovaries. The most common causes are:

• pelvic inflammatory disease
• fibroids (intracavitary or intramural)
• intrauterine contraceptive devices
• endometriosis
• inflammation and scarring(adhesions)
• functional ovarian cysts
• benign or malignant tumors of ovary, bowel or bladder, or other site
• inflammatory bowel disease

Diagnosis

A focused history and physical examination are usually sufficient to make the diagnosis of primary dysmenorrhea. The history reveals the typical cramping pain with menstruation, and the physical examination is completely normal. A doctor should perform a thorough pelvic exam and take a patient history to rule out an underlying condition that could cause cramps. It is usually possible to differentiate dysmenorrhea from premenstrual syndrome (PMS) based on the patient's history. The pain associated with PMS is generally related to breast tenderness and abdominal bloating, rather than a lower abdominal cramping pain. PMS symptoms begin before the menstrual cycle and resolve shortly after menstrual flow begins.

Circumstances that may indicate secondary dysmenorrheal include the following:

• dysmenorrhea occurring during the first one or two cycles after menarche (congenital outflow obstruction)
• dysmenorrhea beginning after 25 years of age
• late onset of dysmenorrhea after a history without previous pain with menstruation (possibly caused by complications of pregnancy: ectopic or threatened spontaneous abortion)
• pelvic abnormality on physical examination; infertility (possible endometriosis, pelvic inflammatory disease or other causes of scarring); heavy menstrual flow or irregular cycles (consider adenomyosis, fibroids, polyps); dyspareunia
• little or no response to therapy with nonsteroidal anti-inflammatory drugs, oral contraceptives, or both

Treatment

Secondary dysmenorrhea is controlled by treating the underlying disorder.

The appropriate choice of therapy for most women with primary dysmenorrheal is a nonsteroidal anti-inflammatory drug (NSAIDs), which prevents the formation and release of prostaglandins. Aspirin is not used for the treatment of dysmenorrheal because it is not potent enough in the usual dosage. Response to NSAIDs usually occurs within 30 to 60 minutes, but since individual response may vary, it is sometimes necessary to try different NSAIDs if the pain is not relieved with the first drug after one or two menstrual cycles. The NSAIDs include ibuprofen, naproxen (Aleve), and Motrin.

If an NSAID is not available, acetaminophen (Tylenol) may help ease the pain. Heat applied to the painful area may bring relief, and a warm bath twice a day also may help. Birth control pills are 90 percent effective in easing the pain of dysmenorrheal. They work by a twofold action: they reduce the menstrual fluid volume and suppress ovulation. They are generally not prescribed initially because it is a daily medication unless the woman also wants a birth control method. They may be chosen as a first line of therapy.

Alternative Treatment

Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen. Likewise, several yoga positions are popular ways to ease menstrual pain. In the "cat stretch," position, the woman rests on her hands and knees, slowly arching the back. The pelvic tilt is another popular yoga position, in which the woman lies on her back with knees bent and then lifts the pelvis and buttocks.

Dietary recommendations to ease cramps include increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar. Smoking also has been found to worsen cramps. Some research suggests that vitamin B supplements, primarily vitamin B6 in a complex, magnesium, and fish oil supplements (omega-3 fatty acids) also may help relieve cramps.

Other women find relief through visualization, concentrating on the pain as a particular color, and gaining control of the sensations. Aromatherapy and massage may ease pain for some women. Others find that imagining a white light hovering over the painful area can actually lessen the pain for brief periods.

Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers. And orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.

Acupuncture and Chinese herbs are additional alternative treatments for cramps.

Prognosis

Medication should lessen or eliminate pain by the end of three menstrual cycles. If it does not work, then a re-evaluation is necessary.

Prevention

NSAIDs taken one to two days before a period begins should eliminate cramps for some women.

Resources

Books

Carlson, K. J., et al. The New Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 2004.

Organizations

National Women's Health Network. 514 10th St. NW, Suite 400, Washington, DC 20004. Web site: www.womenshealthnetwork.org.

Web Sites

Clark, Alan D. "Dysmenorrhea." eMedicine, October 12, 2004. Available online at (accessed December 21, 2004).

[Article by: Linda K. Bennington]

Severe pain during menstruation. This often interferes with training and competition, but it is sometimes possible to change the timing of the menstrual cycle by using contraceptive pills or other substances. It is important thatathletes taking medication to treat dysmenorrhoea check that the medication doesnot include any substances on the World Anti-Doping Agency's 2005 Prohibited List. There is some evidence that regular aerobic exercise reduces the incidence of dysmenorrhoea.

Dysmenorrhea
Classification and external resources
ICD-10	N94.4-N94.6
ICD-9	625.3
DiseasesDB	10634
MedlinePlus	003150
MeSH	D004412

Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe uterine pain during menstruation. While most women 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 is detected.

Contents 1 Primary dysmenorrhea 1.1 Pathophysiology 1.2 Signs and symptoms 1.3 Etiology 1.4 Diagnosis 1.5 Treatments 1.5.1 Nutritional 1.5.2 NSAIDs 1.5.3 Hormonal contraceptives 1.5.4 Non-drug therapies 1.5.5 Other medications and herbal therapies 1.5.6 Hormonal treatments 1.6 Prognosis 1.7 Epidemiology 2 Secondary dysmenorrhea 3 References 4 External links

Primary dysmenorrhea

Pathophysiology

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 not needed and thus shed.

Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents.^[1] Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These substances are thought to be a major factor in primary dysmenorrhea.^[2] 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, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experienced during menstruation.

Compared with other women, females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.^[3]

Signs and symptoms

This section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (June 2008)

The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thighs and lower back. Other symptoms may include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue. Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea, because the birth control pills stop ovulation from occurring.

Etiology

In a systematic review, an age of less than 30 years, a low body mass index, smoking, early menarche (< 12 years), long menstrual cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilization, clinically suspected pelvic inflammatory disease, sexual abuse, and psychological symptoms were associated with dysmenorrhea.^[4]

Diagnosis

In one research study using MRI, visible features of the uterus were compared in dysmenorrheic and eumenorrheic (normal) participants. The study concluded that in dysmenorrheic patients, visible features on cycle days 1-3 correlated with the degree of pain, and differed significantly from the control group.^[5]

Treatments

Nutritional

Several nutritional supplements have been indicated as effective in treating dysmenorrhea, including omega-3 fatty acids, magnesium, vitamin E, zinc, and thiamine (vitamin B₁).

Research indicates that one mechanism underlying dysmenorrhea is a disturbed balance between anti-inflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor eicosanoids derived from omega-6 fatty acids.^[6] 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.^{[7] [8][9]} The richest dietary source of omega-3 fatty acids is found in flax oil.^[10]

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.^{[11] [12]} A randomized, double-blind, controlled trial demonstrated that oral intake of vitamin E relieves the pain of primary dysmenorrhea and reduces blood loss.^[13] 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.^[14] Intake of thiamine (vitamin B₁) was demonstrated to provide "curative" relief in 87% of females experiencing dysmenorrhea, in a controlled study.^[15]

NSAIDs

Non-steroidal anti-inflammatory drugs (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.^[16] NSAIDs can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea.^[17] Patients who cannot take the more common NSAIDs, or for whom they are not effective, may be prescribed a COX-2 inhibitor.^[18] One study indicated that conventional therapy with NSAIDs "provides symptomatic relief but has increasing adverse effects with long-term use",^[19] another indicated that long-term use of NSAIDs has "severe adverse effects".^[20]

Hormonal contraceptives

Although use of hormonal contraception can improve or relieve symptoms of primary dysmenorrhea,^[21][22] a 2001 systematic review found that no conclusions can be made about the efficacy of commonly used modern lower dose combined oral contraceptive pills for primary dysmenorrhea.^[23] Norplant^[24] and Depo-provera^[25][26] are also effective, since these methods often induce amenorrhea. The IntraUterine System (Mirena IUD) has been cited as useful in reducing symptoms of dysmenorrhea.^[27]

Non-drug therapies

Several non-drug therapies for dysmenorrhea have been studied, including behavioral, acupuncture, acupressure, chiropractic care, and the use of a TENS unit.

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.^[28]

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.^[29] 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",^[30] still another indicated that adding acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life.^[31]

Although claims have been made for chiropractic care, under the theory that treating subluxations in the spine may decrease symptoms,^[32] a 2006 systematic review found that overall no evidence suggests that spinal manipulation is effective for treatment of primary and secondary dysmenorrhea.^[33]

Treatment with a transcutaneous electrical nerve stimulation (TENS) unit, often used for chronic pain, was indicated as effective in several studies.^{[34] [35] [36][37]} 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".^[38] A study led by the same researchers reported proof of TENS' effectiveness.^[39] An alternative to this is a hot water bottle on the effected area. The heat relaxes the muscles in the area and provides a temporary relief to the pain experienced.

Other medications and herbal therapies

Other medications and herbal therapies have been studied in the treatment of dysmenorrhea. A 2008 systematic review found promising evidence for Chinese herbal medicine for primary dysmenorrhea, but that the evidence was limited by its poor methodological quality.^[40] One study indicated that two Japanese herbal medicines provided all of the study participants with complete relief.^[41] A review indicated the effectiveness of use of transdermal nitroglycerin.^[42] A double-blind, controlled study indicated that treatment with an extract of guava leaf resulted in significant reduction of symptoms.^[43] In a small double-blind, placebo-controlled study, guaifenesin reduced primary dysmenorrhea, but the effect was not significant.^[44]

Hormonal treatments

One study suggested that vasopressin antagonists with V1(a) selectivity might be useful in treating a variety of disorders, including dysmenorrhea.^[45]

Prognosis

A survey in Norway showed that 14 percent of females between the ages of 20 to 35 experience symptoms so severe that they stay home from school or work.^[46] Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school absence in this group.^[47]

Epidemiology

Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. One study indicated that 67.2% of adolescent females experienced dysmenorrhea.^[48] A study of Hispanic adolescent females indicated a high prevalence and impact in this group.^[49] Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity.^[50] Childbearing is said to relieve dysmenorrhea, but this does not always occur. One study indicated that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40. ^[51] A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in females who had been sexually abused.^[52]

Secondary dysmenorrhea

This section requires expansion.

Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis.^[47] Other causes include leiomyoma,^[53] adenomyosis,^[54] ovarian cysts, and pelvic congestions.^[55] The presence of a copper IUD can also cause dysmenorrhea.^[56][57] In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was observed to provide relief.^[58]

References

1. ^ Lethaby A, Augood C, Duckitt K, Farquhar C (2007). "Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding". Cochrane Database Syst Rev (4): CD000400. doi:10.1002/14651858.CD000400.pub2. PMID 17943741. 
2. ^ Wright, Jason and Solange Wyatt. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams and Wilkins, 2003. ISBN 0-7817-4363-X
3. ^ Rosenwaks Z, Seegar-Jones G (October 1980). "Menstrual pain: its origin and pathogenesis". J Reprod Med 25 (4 Suppl): 207–12. PMID 7001019. 
4. ^ Latthe P, Mignini L, Gray R, Hills R, Khan K (2006). "Factors predisposing women to chronic pelvic pain: systematic review". BMJ 332 (7544): 749–55. doi:10.1136/bmj.38748.697465.55. PMID 16484239. 
5. ^ Kataoka M, Togashi K, Kido A, et al. (2005). "Dysmenorrhea: evaluation with cine-mode-display MR imaging--initial experience". Radiology 235 (1): 124–31. doi:10.1148/radiol.2351031283. PMID 15731368. 
6. ^ Xu L, Liu SL, Zhang JT (2005). "(-)-Clausenamide potentiates synaptic transmission in the dentate gyrus of rats". Chirality 17 (5): 239–44. doi:10.1002/chir.20150. PMID 15841477. 
7. ^ Deutch B (1996). "[Painful menstruation and low intake of n-3 fatty acids]" (in Danish). Ugeskr. Laeg. 158 (29): 4195–8. PMID 8701537. 
8. ^ Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL (1996). "Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents". Am. J. Obstet. Gynecol. 174 (4): 1335–8. doi:10.1016/S0002-9378(96)70681-6. PMID 8623866. 
9. ^ Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules), ScienceDirect
10. ^ Prasad K (1997). "Dietary flax seed in prevention of hypercholesterolemic atherosclerosis". Atherosclerosis 132 (1): 69–76. doi:10.1016/S0021-9150(97)06110-8. PMID 9247361. http://linkinghub.elsevier.com/retrieve/pii/S0021-9150(97)06110-8.  "Flax seed is the richest source of omega-3 fatty acid and lignans."
11. ^ Seifert B, Wagler P, Dartsch S, Schmidt U, Nieder J (1989). "[Magnesium--a new therapeutic alternative in primary dysmenorrhea]" (in German). Zentralbl Gynakol 111 (11): 755–60. PMID 2675496. 
12. ^ Fontana-Klaiber H, Hogg B (1990). "[Therapeutic effects of magnesium in dysmenorrhea]" (in German). Schweiz. Rundsch. Med. Prax. 79 (16): 491–4. PMID 2349410. 
13. ^ Ziaei S, Zakeri M, Kazemnejad A (2005). "A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoea". BJOG 112 (4): 466–9. doi:10.1111/j.1471-0528.2004.00495.x. PMID 15777446. 
14. ^ Eby GA (2007). "Zinc treatment prevents dysmenorrhea". Med. Hypotheses 69 (2): 297–301. doi:10.1016/j.mehy.2006.12.009. PMID 17289285. 
15. ^ Proctor M, Farquhar C (2006). "Diagnosis and management of dysmenorrhoea". BMJ 332 (7550): 1134–8. doi:10.1136/bmj.332.7550.1134. PMID 16690671. PMC 1459624. http://www.bmj.com/cgi/content/full/332/7550/1134. 
16. ^ Andreoli, Thomas E., Charles C. J. Carpenter, Robert C. Griggs, and Joseph Loscalzo. CECIL Essentials of Medicine, 6th ed. Saunders, 2004. ISBN 0-7216-0147-2
17. ^ Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3
18. ^ Chantler I, Mitchell D, Fuller A (2008). "The effect of three cyclo-oxygenase inhibitors on intensity of primary dysmenorrheic pain". Clin J Pain 24 (1): 39–44. doi:10.1097/AJP.0b013e318156dafc. PMID 18180635. 
19. ^ Jia W, Wang X, Xu D, Zhao A, Zhang Y (2006). "Common traditional Chinese medicinal herbs for dysmenorrhea". Phytother Res 20 (10): 819–24. doi:10.1002/ptr.1905. PMID 16835873. 
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External links

Dysmenorrhea at the Open Directory Project

v • d • e Diseases of the pelvis and genitals (N40-N99, 600-629) Female Adnexa Ovary Oophoritis · Ovarian cyst (Follicular cyst of ovary, Corpus luteum cyst, Chocolate cyst of ovary) · Ovarian hyperstimulation syndrome · Anovulation · Mittelschmerz Fallopian tube Salpingitis · Hydrosalpinx · Hematosalpinx · Fallopian tube obstruction Parametrium Parametritis Uterus Endometrium: Endometriosis (Adenomyosis) · Endometrial polyp menstruation: flow (Amenorrhoea, Hypomenorrhea, Oligomenorrhea) · timing (Menorrhagia, Menometrorrhagia, Metrorrhagia) · pain (Dysmenorrhea) Hematometra · Retroverted uterus · Asherman's syndrome Cervix Cervicitis · Cervical polyp · Nabothian cyst · Cervical incompetence Vagina Vaginitis (Bacterial vaginosis, Atrophic vaginitis, Candidal vulvovaginitis) · Leukorrhea · Hematocolpos/Hydrocolpos Sexual dysfunction (Dyspareunia, Hypoactive Sexual Desire Disorder, Sexual arousal disorder, Vaginismus) Prolapse (Cystocele, Rectocele, Urethrocele) · Fistulae (Vesicovaginal, Rectovaginal) Vaginal discharge Vulva Vulvitis · Bartholin's cyst Clitoral hood or Clitoris Clitoral phimosis · Clitorism Other/general Pelvic inflammatory disease · Female infertility (Habitual abortion) · Pelvic congestion syndrome Male Testicular Orchitis · Hydrocele testis · Testicular torsion · Male infertility (Azoospermia, Oligospermia) Epididymis Epididymitis · Spermatocele · Hematocele Prostate Prostatitis (Acute prostatitis, Chronic bacterial prostatitis, Chronic prostatitis/chronic pelvic pain syndrome) · Benign prostatic hyperplasia Penis Balanoposthitis/Balanitis · Phimosis · Priapism · Sexual dysfunction (Erectile dysfunction) · Peyronie's disease · Penile fracture Other Hematospermia · Retrograde ejaculation reproductive system navs: anat female,male/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

v • d • e Menstrual cycle Events and phases Menstruation · Follicular phase · Ovulation · Luteal phase Life stages Menarche · Menopause Tracking Signs Basal body temperature · Cervical mucus · Mittelschmerz Systems Fertility awareness · Calendar-based methods · Billings Ovulation Method · Creighton Model Suppression Extended cycle combined hormonal contraceptive · Lactational amenorrhea method Disorders Amenorrhoea · Anovulation · Dysmenorrhea · Hypomenorrhea · Menometrorrhagia · Menorrhagia · Metrorrhagia · Oligomenorrhea Related events Folliculogenesis · McClintock effect · Premenstrual syndrome In culture and religion Chhaupadi · Menstrual taboo · Niddah reproductive system navs: anat female,male/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

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