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Dysmenorrhea

Dysmenorrhea is defined as painful menstrual cramps and may be classified as either primary or secondary. The most common form of dysmenorrhea is the primary type, which is marked by the absence of gross pathological conditions in the pelvic organs. Conversely, secondary dysmenorrhea is a result of an organic pelvic disorder. An estimated 50% of menstruating women experience dysmenorrhea, with 10% becoming incapacitated for several days each period. The pain associated with dysmenorrhea is thought to be due to three factors: (1) increased abnormal uterine activity, (2) uterine ischemia, (3) sensitization of nerve terminals to prostaglandins (compounds that have a powerful hormone effect) by lowering of the threshold of the nerve terminals to the action of chemical or physical stimuli.
Symptoms
In dysmenorrhea the pains are spasmodic in character, strongest over the lower abdomen, and may radiate to the back or along the thighs. Pelvic pain is accompanied by one or more of the following symptoms in more than 50% of patients: low backache 60%; nausea or vomiting 89%; diarrhea 60%; headache 45%; and fatigue 85%. The pain usually begins some hours before the appearance of visible vaginal bleeding. It is most intense on the first day of menstruation and may last from a few hours to one day, but seldom exceeds two or three days.
Management/Treatment
Usually females suffering from dysmenorrhea resort to over the counter medications such as Midol, cramp relivers, aspirin, Tylenol and Advil. Other successfully reported modes of therapy include heat, exercise, rest, and simple psychotherapy (in the form of dialogue, discussion, and physician reassurance). Primary dysmenorrhea, in particular, may be treated with either oral contraceptives or prostaglandin synthetase inhibitors. If the patient does not respond to the medication therapy, pelvic pathology should be considered via indication of laparoscopy.

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