The pain can be dull or throbbing usually in the lower
abdomen or pelvis. It may start several days before
menstruation or may accompany it. The intensity of
pain varies from woman to woman. It can be mild or
severe enough to interfere with daily activities.
Dysmenorrhea can be primary or secondary. Primary dysmenorrhea - refers to menstrual pain that does
not involve any physical abnormality. Thepain is not
related to any specific problems with the uterus or
other pelvic organs.
Secondary dysmenorrhea - is
menstrual pain that is attributed to some underlying
physical cause such as Endometriosis, Pelvic
inflammatory disease or Uterine fibroids.
Menstruation has always been a point of much
discussion among various communities in the world
and the start of menstruation is often associated with
religious rituals.
CAUSES
Prostaglandins cause
contraction of the uterus and their levels are found to be higher in women with menstrual pain.
"Prostaglandin theory" adequately explains the
reason for the pain. Prostaglandins are hormone like substances that are produced by the uterus and bring about contraction of the muscles of uterus. Their levels are found to be higher in women with
menstrual pain. A number of factors may be involved for pain during menstruation. However recent research has confirmed that the Prostaglandins -»Trigger the contraction of muscles of uterus -»Narrowing of diameter of small blood vessels of uterus -» Temporary shut down of blood supply to uterus -» Depriving muscles of oxygen -» Menstrual cramps
The release of prostaglandins is mainly due to
the hormone progesterone, released by the corpus
luteum (a product of the ovaries). There maybe no
pain during the first year of menarche, as in over
60% of the initial menstrual cycles there is no
production of the egg (called anovulatory phase).
Since ovulation is associated with the release of egg
and normal corpus luteal activity, it is associated
with painful menstruation. The Risk factors for
primary dysmenorrhea include – Early onset of
menarche, Never having carried a pregnancy
(Nulliparity), Obesity, Cigarette Smoking Family
history Secondary dysmenorrhea is attributed to a
number of causes, some of which include-
Prostaglandins- The concentration of prostaglandins in the endometrium is increased in the presence of intrauterine contraceptive devices like -Copper T, Multiload device and in conditions like fibroid uterus.
Obstructive and anatomical factors –Acute uterine
ante flexion or retro flexion, cervical stenosis,
pedunculated sub mucous fibroid and endometrial
polyps can cause secondary dysmenorrhea. Other less common causes are— Endometriosis, Adenomyosis and Blind uterine horn. The risk factors for secondary
dysmenorrhea are sexually transmitted diseases and
Endometritis.
SYMPTOMS
Primary dysmenorrhea
usually presents during adolescence and begins
within three years of menarche. Pain begins with the
onset of menstruation and lasts for a few hours and
can be spasmodic and colicky. There can also be a
feeling of an ache or heaviness in the lower middle
section of the abdomen and sometimes may radiate
to the lower back and legs. The first day of
menstruation is the worst when the pain is most
severe. Numerous symptoms accompany, including
nausea, vomiting headache, loose stools, dizziness
and fatigue. The cramps tend to decrease in intensity
and completely disappear after childbirth. In
secondary dysmenorrhea the onset of symptoms is
later in life. The symptoms usually begin a few days
before the onset of menstruation and last several days
after the start of bleeding.
TREATMENT
Treatment
of dysmenorrhea is by giving analgesics that work by suppressing prostaglandin production. In secondary
dysmenorrhea treatment depends upon the
underlying cause. Primary Dysmenorrhea is usually
treated with anti prostaglandins medication. Most
patients show improvement with drugs called - Non- steroidal anti – inflammatory (NSAID) drugs.
Certain general measures can help to reduce the
severity of the symptoms and avoid medications.
General measures
Heat – Apply a heating pad to the lower abdomen.
Self-massage – Do circular massage with the fingertips around lower abdomen.
Exercise – Walk or exercise regularly.
Diet – Eat light and frequent meals. Increase intake of complex carbohydrates and decrease intake of salt, sugar, alcohol and caffeine.
Stress reduction – Practicing techniques like meditation and yoga can reduce stress. Drugs Prostaglandin synthetase inhibitors
drugs called - Non-steroidal anti – inflammatory
drugs (NSAID) In secondary Dysmenorrhea
treatment depends upon the underlying cause. This
could include Treating with antibiotics for pelvic
infection Surgical removal of fibroids or polyps in
uterus. Dilatation of a narrow cervical canal. Treating endometriosis.
Source: pharmradiong..com