Dysmenorrhea: Causes, Symptoms, Diagnosis & Treatment
Dysmenorrhea
Dysmenorrhea or painful cramping occurs with the onset and first days of menstruation. It is otherwise called dysmenorrhoea, difficult periods, or menstrual cramps. Typical torment or distress is normal during this period. However, if the aggravation makes you miss your work or day-by-day undertakings, it alludes to dysmenorrhea.
It can be classified as either primary (without underlying uterine pathology) or secondary (owing to underlying uterine pathology). Secondary dysmenorrhea can result from uterine conditions, including endometriosis, uterine polyps, or fibroids; complications of intrauterine device (IUD) use; or pelvic inflammatory disease.
Up to 93% of adolescents report some pain with menstruation and up to 15% experience pain that is sufficiently severe and disabling to interfere with activities of daily life. Dysmenorrhea is the single largest cause of lost productivity and school absence among adolescent girls.
It most commonly begins within 1 to 2 years after the onset of menses. The prevalence of primary dysmenorrhea decreases with age, although menstrual cramps can occur in up to 50% of menstruating women regardless of age.
Females younger than 30 and unmarried young ladies are at higher danger of developing dysmenorrhea. The danger of dysmenorrhea diminishes with expanding age. Family background of difficult periods, sporadic or irregular periods, substantial heavy monthly cycles, and smoking increases the danger of dysmenorrhea. Some factors such as younger age (less than 20 years of age), depression or anxiety, nulliparity, and menorrhagia increase the risk of dysmenorrhea.
Causes Of Dysmenorrhea
Primary dysmenorrhea occurs only with ovulatory cycles, which typically begin after the first year following menarche. Dysmenorrhea occurring several years after menarche is most likely secondary dysmenorrhea, and should be investigated as such.
Primary and secondary dysmenorrhea is brought about by various elements. Primary dysmenorrhea isn't brought about by different infections. Primary dysmenorrhea is brought about by the expanded production of prostaglandin which causes uterine withdrawal too firmly.
Secondary dysmenorrhea is brought about by pelvic or uterine illnesses like endometriosis, uterine fibroids, adenomyosis, pelvic inflammatory disease, premenstrual condition (PMS), and cervical stenosis. Endometriosis is a condition wherein cells like those of the endometrium begin to develop outside of your uterine hole. Fibroids are strange or noncancerous developments that can fill in and on your uterus.
Adenomyosis is a condition wherein endometrial tissue develops into a solid mass of the uterus (myometrium). Pelvic inflammatory disease is an incendiary state of the female contraceptive or reproductive organs, the pelvic cavity. The premenstrual disorder causes a mix of passionate, physical, and mental unsettling influences 5-10 days before the beginning of the monthly cycle. Cervical stenosis is a condition where the feminine stream turns out to be delayed because of the narrowing of the cervix bringing about expanded tension in the uterus.
In the normal menstrual cycle, prostaglandins are released by the endometrium in the late luteal phase inducing contraction of the uterine smooth muscle and subsequent sloughing of the endometrium, leading to menstrual flow and the beginning of the follicular phase of the next cycle.
Women with primary dysmenorrhea appear to have increased prostaglandin secretion, inducing more intense uterine contractions, leading to decreased uterine blood flow and uterine hypoxia, which results in cramping and pain that are the hallmarks of dysmenorrhea.
The decreasing levels of progesterone in the late luteal phase trigger the release of arachidonic acid from cell membranes, ultimately resulting in the production of prostaglandins F2α (PGF2α), and PGE2, and leukotrienes.
Each of these prostaglandins produces pain and uterine contractions similar to those observed in women with primary dysmenorrhea. These prostaglandins, with potent platelet disaggregation and vasodilatory properties, also induce nausea, vomiting, and diarrhea.
Symptoms Of Dysmenorrhea
The seriousness or severity of symptoms of dysmenorrhea appears to correspond with ladies who have early menarche (beginning of menses before age 8) and those with expanded span and amount of menstrual flow.
The clinical presentation that is typical of primary dysmenorrhea includes cramping or squeezing pain in the suprapubic region, which may radiate into the back and thighs, nausea, and diarrhea. The cramping pain is sharp, dull, or labor-like in nature and lasts for about 12 to 72 hours.
A few ladies additionally experience retching, exhaustion, headache, lightheadedness, flushing, loss of hunger, irritability, anxiety, insomnia, and a sleeping disorder.
The typical pattern of dysmenorrhea is to have pain beginning up to 12 hours before menses, increasing in severity for up to 24 hours, and continuing with reduced intensity for 24 to 72 hours.
Diagnosis Of Dysmenorrhea
No specific diagnostic criteria exist for primary dysmenorrhea. Typically, the diagnosis is one of exclusion and is based on a response to known effective therapy.
Thus, if patients do not respond to therapy, an investigation of pelvic pathology and secondary dysmenorrhea should occur. For this purpose, CT scans, MRIs, and ultrasounds are recommended.
Treatment Of Dysmenorrhea
There are three treatment approaches used in dysmenorrhea depending upon the causative agent, pharmacological, non-pharmacological, and surgical treatment. Over-the-counter painkillers are used for the treatment of pain.
The purpose of treatment in dysmenorrhea is to reduce the activity of prostaglandin. Anti-inflammatory drugs are recommended because they act by inhibiting the synthesis of prostaglandin.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used for the relief of pain of primary dysmenorrhea for most women. Naproxen, ibuprofen, and ketoprofen are approved for the treatment of primary dysmenorrhea.
NSAIDs or hormonal contraceptives may be required for adequate relief. Hormonal contraceptives reduce the amount of endometrial proliferation and, as a result, decrease the number of prostaglandins secreted. By inhibiting ovulation, hormonal contraceptives eliminate the cyclic changes in progesterone that induce prostaglandin release. The choice of therapy depends on the need for contraception, concomitant medical conditions, and patient preference.
The cyclo-oxygenase-2 selective inhibitor, celecoxib, is approved for the treatment of primary dysmenorrhea; it has not been directly compared with conventional NSAIDs for the treatment of pain. The FDA-approved dosing of celecoxib is a 400-mg loading dose, followed by 200 mg that same day if needed, then 200 mg twice daily thereafter.
Hormonal contraceptives may be an option if NSAIDs are not effective for the treatment of dysmenorrhea. Oral contraceptives (OCs) suppress ovulation, decrease menstrual fluid volume, and subsequently decrease prostaglandin production and uterine cramping. Hormonal contraceptives in the form of birth control pills, patches, and vaginal rings can also be prescribed. The levonorgestrel oral contraceptive pill is the most commonly used oral contraceptive. Oral contraceptives (OCs) relieve dysmenorrhea symptoms in 50% to 80% of women within 3 to 6 months after beginning hormone therapy.
Your PCP can likewise recommend intrauterine devices (IUDs) for the treatment of dysmenorrhea. This strategy is extremely compelling for birth control. It is a T-shaped device that is set in your uterus during a little surgery. It is exceptionally viable in treating heavy bleeding.
The levonorgestrel intrauterine system (IUS) is associated with amenorrhea and a reduction in dysmenorrhea over time, unlike the copper IUD, which may result in increased pain, cramping, and blood loss. A medroxyprogesterone depot injection is another hormonal contraceptive agent that has been used to treat primary dysmenorrhea.
On the off chance that your menstrual cramps are brought about by an issue like endometriosis or fibroids, medical procedures to address the issue may help your symptoms. Surgical evacuation of the uterus additionally may be a choice if different methodologies neglect to facilitate your manifestations and in case you're not wanting to have kids.
Aerobic exercise, heat therapy, tobacco cessation, omega-3 polyunsaturated fatty acids, and high-frequency transcutaneous electrical nerve stimulation (TENS) are non-pharmacological strategies used for the treatment of dysmenorrhea. Acupuncture has been evaluated as a treatment option for primary dysmenorrhea. Vitamin E, vitamin B-1 (thiamin), vitamin B-6 and magnesium supplements are also effective for the treatment of menstrual cramps.