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Dysmenorrhea is the medical term for painful periods or menstrual cramps. The majority of women are thought to experience some degree of dysmenorrhea.
Dysmenorrhea is either primary or secondary.
Incidence; Causes & Development
Primary dysmenorrhea frequently affects women in their teens and early 20s, who have never had a baby.
The symptoms are caused by prostaglandin, a natural hormone produced by cells in the uterine lining. The level of prostaglandin increases in the second half of the menstrual cycle. When a woman's period begins, the cells in the uterine lining release prostaglandin as they are shed. Women with severe primary dysmenorrhea have significantly higher prostaglandin levels in their menstrual fluid than do other women. Usually the symptoms do not last very long - one or two days, but rarely longer.
Secondary dysmenorrhea is caused by a variety of uterine conditions. Women who suffer from it tend to be older than those with primary dysmenorrhea.
Signs & Symptoms
In cases of primary dysmenorrhea, no disease or other medical cause can be found for the pain and other symptoms, which may include backache, diarrhea, dizziness, headache, nausea, vomiting, and a feeling of tenseness.
Treatment & Prevention
Secondary dysmenorrhea. On physical exam and/or ultrasound, if everything is normal, the doctor might recommend prostaglandin-inhibiting medications such as aspirin, ibuprofen, or naproxen. The birth-control pill is sometimes recommended, as it stops ovulation and decreases prostaglandin levels.
In cases of secondary dysmenorrhea, dilation and curettage (D&C) may be recommended to open the cervix and remove tissue for microscopic testing. Once the reason for your secondary dysmenorrhea has been found, your doctor will be able to discuss an appropriate treatment with you. You might also be advised to use prostaglandin-inhibiting drugs or the birth-control pill to relieve symptoms.
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Signs, symptoms & indicators of Painful Menstruation (Dysmenorrhea):
Risk factors for Painful Menstruation (Dysmenorrhea):
Painful Menstruation (Dysmenorrhea) suggests the following may be present:
Recommendations and treatments for Painful Menstruation (Dysmenorrhea): | | | | | Digestion |  Bromelain | Bromelain at 250 to 500mg can be taken 3 to 4 times per day on an empty stomach. Fish oil and bromelain make a powerful anti-inflammatory combination. |
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Drug |
NSAIDs| | Anti-inflammatories such as Motrin, while useful for the management of acute pain, do little to deal with any underlying causes. |
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Habits |
Aerobic Exercise| | Regular exercise can help minimize pain and cramping. |
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Mineral |
Magnesium| | Menstrual cramps, irritability, fatigue, depression, and water retention have been lessened with magnesium, usually given along with calcium and often with vitamin B6. Magnesium is often at its lowest level during menstruation. In acute cases, magnesium and vitamin B6 intravenously can stop the cramping. Restoring magnesium sufficiency by consistent supplementation can work to prevent this problem. |
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Nutrient |
Essential Fatty Acids| | Long-term improvement may be gained by promoting the build up of anti-inflammatory prostaglandins with Omega-3 fatty acids or fish oil. Six grams of fish oil per day (or about 1,000mg of eicosapentanoic acid, 700mg of docosahexaenoic acid) can be taken every day for 2 or 3 cycles and then reduced, or taken for a total of 14 days starting 10 days before your period. |
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Vitamins |
 Vitamin B1 (Thiamine)| | In a well-designed controlled trial of 556 girls with moderate to severe menstrual cramping, vitamin B1 (100mg daily by mouth) for 3 months produced startling results. 87% were cured, 8% were almost completely relieved, while only 5% were not benefited at all. [ Indian J Med Res May, 1996;103: pp.227-31] |
Vitamin B6 (Pyridoxine)
Vitamin E| | Supplementation with vitamin E (500 IU per day) from 2 days before menstrual onset through the third day of bleeding, for two consecutive menstrual cycles, reduced pain in a placebo-controlled trial of 100 young women with primary dysmenorrhea. [BJOG 2001;108(11): pp.1181-3]
Another study used vitamin E successfully at a dosage of 75-400 IU tid. [Butler & McKnight. Lancet 1: pp.844-47, 1955] |
Inositol Hexaniacinate| | There is evidence that niacin may be beneficial for the treatment of dysmennorhea. Hudgins reported on a group of 80 women suffering from painful menstrual cramps who were supplemented with 100mg niacin twice daily, beginning 7 to 10 days before the onset of menses and then every 2 to 3 hours during heavy cramps. 90% of participants experienced significant relief. It should be noted that the dosage required during heavy cramping is high enough to cause unpleasant side effects and that it would seem that the use of flush-free niacin (inositol hexaniacinate) might be indicated. In addition, the inositol would provide lipotropic effects. Lipotropic agents help in the metabolism of hormones by the liver, important for the prevention of PMS. |
 Vitamin B3 (Niacin)| | Niacin (and possibly flush-free niacin) at 100mg every 2 to 3 hours in acute cases has been used. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Highly recommended |
GLOSSARY
Acute
An illness or symptom of sudden onset, which generally has a short duration.
Adrenal (Adrenal Gland, Adrenal Glands, Adrenals)
The adrenal glands sit on top of each kidney and consist of an outer cortex and an inner medulla. Of the 50 or so hormones the adrenals make, only cortisone and adrenaline are recognized by most people. Some of these hormones must be produced to preserve life, while others help resist stress. Other hormones from the adrenals control normal energy output (along with the thyroid) and govern the breakdown of stored energy into quick energy sources. The medulla produces epinephrine and norepinephrine, which are specifically designed to help the body deal with stressful situations. The adrenals control the body's potassium/sodium balance, which is vital for energy production. They also produce sex hormones in minute amounts, which is important for later years when the gonads drop or cease their production.
Anti-inflammatory (Antiinflammatory)
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Calcium
The body's most abundant mineral. Its primary function is to help build and maintain bones and teeth. The body also needs calcium to carry nerve signals, keep the heart functioning, contract muscles, clot blood and maintain healthy skin. Calcium helps control blood acid-alkaline balance, plays a role in cell division, muscle growth and iron utilization, activates certain enzymes, and helps transport nutrients through cell membranes. Calcium also forms a cellular cement called ground substance that helps hold cells and tissues together.
Cervix
The lower part of the uterus that opens into the vagina.
Cortisol
A hormone. Its most important function is to help the body respond to stress. It also helps regulate your body's use of protein, carbohydrates and fat; it helps maintain blood pressure and cardiovascular function; it stems inflammation.
Cramp (Cramping, Cramps)
A sudden, involuntary, painful muscular contraction.
Diarrhea
Excessive discharge of contents of bowel.
Dilation and Curettage (D&C)
The scraping of the lining of the uterus (the endometrium). There are two main reasons for performing a D&C: to remove tissue remaining in the womb in a recently pregnant woman, and as part of the investigation of a woman who is experiencing heavy or irregular periods or vaginal bleeding after menopause.
Dysmenorrhea
Difficult or painful menstruation.
Endometriosis
A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.
Fatty Acids (Fatty Acid)
Chemical chains of carbon, hydrogen, and oxygen atoms that are part of a fat (lipid) and are the major component of triglycerides. Depending on the number and arrangement of these atoms, fatty acids are classified as either saturated, polyunsaturated, or monounsaturated. They are nutritional substances found in nature which include cholesterol, prostaglandins, and stearic, palmitic, linoleic, linolenic, eicosapentanoic (EPA), and decohexanoic acids. Important nutritional lipids include lecithin, choline, gamma-linoleic acid, and inositol.
Gram (gm, gms, Gramme, Grammes, Grams)
A metric unit of weight, there being approximately 28 grams in one ounce.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Inositol
Usually considered part of the vitamin B complex. It is thought that along with choline, inositol is necessary for the formation of lecithin within the body. Involved in calcium mobilization.
IU (mIU, uIU)
International Unit: An arbitrarily defined but agreed upon unit that depends on what is being measured.
mIU: 0.001 or one thousandth of an IU.
uIU: 0.000001 or one millionth of an IU.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Metabolism (Metabolic, Metabolize, Metabolizes, Metabolizing)
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds. Also defined as the sum total of changes in an organism in order to achieve a balance (homeostasis): Catabolic burns up, anabolic stores and builds up; the sum of their work is metabolism.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Nausea
Symptoms resulting from an inclination to vomit.
Niacin (B3, B-3, Niacinamide, Vitamin B3)
A coenzyme B-complex vitamin that assists in the breakdown of carbohydrates, fats and proteins. Essential for the health of the skin, nerves, tongue and digestive system. It is found in every cell of the body and is necessary for energy production. Niacin is also needed for DNA formation.
Premenstrual Syndrome (PMS)
PMS consists of various physical and/or emotional symptoms that occur in the second half of the menstrual cycle, after ovulation. The symptoms begin about midcycle, are generally the most intense during the last seven days before menstruation and include: acne; backache; bloating; fatigue; headache; sore breasts; changes in sexual desire; depression; difficulty concentrating; difficulty handling stress; irritability; tearfulness.
Prostaglandin (Prostaglandins)
Any of a class of physiologically active substances present in many tissues, with effects such as vasodilation, vasoconstriction, stimulation of the smooth muscles of the bronchus or intestine, uterine stimulation; also involved in pain, inflammation, fever, allergic diarrhea, and dysmenorrhea. A potent hormone -- similar in structure to an unsaturated fatty acid -- that acts in extremely low concentrations on local target organs; first isolated from the prostate.
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Thiamine (B1, B-1, Thiamin, Vitamin B1)
A B-complex vitamin that acts as a coenzyme necessary for the conversion of carbohydrates into glucose, which is burned in the body for energy. It is essential for the functioning of the nervous system.
TID
Three times a day.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Vitamin B6 (B6, B-6)
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
Last updated: Apr 13, 2008
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