Menstrual Cramps (Dysmenorrhea): Symptoms, Causes and Treatment

Dysmenorrhea Menstrual Cramps

Menstrual cramps are the pains that women feel before or during her menstrual period. This pain is usually felt in the lower abdomen and last for two to three days. The pains can be characterized by : throbbing or aching, dull or sharp. 

During the menstrual cycle, women can feel mild cramps to severe cramping. Some of these cramps can make women to be bed-ridden and at this stage the condition is now called dysmenorrhea

Women who suffer from menstrual cramps often complain about pain in their waist, leg, inguinal region. 

Here are the definition, symptoms, causes and healthy treatment of the Dysmenorrhea :

What is Dysmenorrhea ?

This a gynecological problem affecting more than 90% of adolescent girls and over than 50% of menstruating women. This is said to be the leading cause of absenteeism for women under the age of 30.  Yet, most women don’t treat it a medical condition because they believe it is common problem that recurs monthly. 

Common symptoms of Dysmenorrhea

  • headache, 
  • dizziness, 
  • back pain, 
  • diarrhea, 
  • vomiting, 
  • and fatigue.

Risk factors include;

  • early onset of periods i.e. below eleven years.
  • Having heavy menstrual periods.
  • Being overweight or obese
  • Substance abuse, e.g. smoking and alcohol
  • Women who have never been pregnant. 

What causes dysmenorrhea

Production of excess prostaglandins, chemicals made by the tissues lining the uterus. These chemicals are necessary as they are responsible for the uterine muscle contraction.

The contractions are supposed to happen swiftly as a part of the menstrual cycle, and the abnormal amounts of prostaglandin causes intense contraction and hence the pain and discomfort. Other causes include; 

  • Endometriosis – the abnormal growth of tissues that appears outside the uterus
  • Fibroids and adenomyosis — benign growths of noncancerous tissues in the uterus.
  • Ovarian cyst
  • Infections in the reproductive organs
  • Ectopic pregnancy (pregnancy in the tubes, outside the uterus)
  • intra-uterine device used as contraceptives.
  • Cervix stenosis, cervix that is too thin and thus obstruct menstrual flow.
  • Pelvic inflammatory disease. female reproductive organs infection often caused sexually transmitted bacteria.

Endometriosis

Your uterus has tissues that lines it up, only on the inside and these tissues are called endometrium.  There are cases where these tissues begin to abnormally grow outside your uterus causing menstrual disorders. Such abnormalities are referred to as endometrial implants. 

These tissues have a tendency of growing on the organs and other linings. The ovaries and the fallopian tubes are the most areas where the abnormal tissues target to grow. The tissue is shed up with the menstrual cycle can become trapped over time resulting in scarring, and cysts inflammation. 

Stages of endometriosis

These depend on the location, depth, size, and amount of tissue outside the uterus. Symptoms and treatment is influenced by the kind of endometriosis

Minimal
  • Small wounds are few
  • Found in the organ or tissue lining. 
  • Very little scarring 
Mild
  • More tissue growth that are even deeper than mild stage.
  • There is little scarring on the lining and the organ at this stage. 
Moderate 
  • Small cysts begin to develop on both ovaries. 
  • The implants are now deep. You may also have
  • adhesions or scarring thickens. 
Severe
  • The tissue implants are now widespread. 
  • The implants are deeper and the adhesions are thicker. 
  • Enlarged cysts on one or both ovaries.

Endometriosis is such a serious condition and it can affect fertility. Reports says that women with mild or moderate endometriosis were able to conceive at least within the first three years without the appropriate treatment.  

There are other serious symptoms of endometriosis;

  • lower abdominal pain,
  • irritable bowel syndrome (IBS) i.e. running stomach and/or constipation,
  • low back pain,
  • chronic fatigue
  • irregular periods
  • heavy menstruation,
  • painful urination, or
  • bloody urine during menstruation.

Uterine Fibroids 

The muscle tissue of the woman’s uterus can have the non-cancerous growth which contribute to menstrual cramps. These growth is referred to as Uterine Fibroids or Myoma. 

The fibroids may grow on the outer surface of the uterine or within the uterine wall, as well as inside the uterus. Sometimes the fibroids form a stem-like structure attaching itself to the uterus. 

A woman can have one or more fibroids in varying sizes that grows in size. However, it is not known why these fibroids grow or what makes them grow as they can remain in one size for years only to rapidly increase in size suddenly.  

Risk groups

They can occur to any woman who still have their periods but they are most common in women aged 30 – 40 years. According to The American College of Obstetricians and Gynecologists African American (2018) women are more affected than the white or Caucasian. 

Younger African American women are said to suffer from uterine fibroids and the growth of the fibroids seem rapid as well. 

Symptoms of fibroids

  • Menstruation cycle changes to become shorter, longer, more frequent, or heavier than usual.
  • Most menstrual pain (cramps) are a result of fibroids
  • bleeding of the vagina when a woman is not menstruating. 
  • being anemic due to excessive bleeding
A feeling of pain;
  • On the abdomen
  • On the lower back
  • During sex
Pressure
  • Difficulty urinating or frequent urination
  • Irregular bowel movement leading to rectal pain
  • When the fibroids grow in size the uterus and abdomen get distended
  • Leading cause of recurrent miscarriages
  • Women may fail to fall pregnant. 

In some rare cases women with fibroids may have no symptoms at all. In this case, a woman will only find out during a routine pelvic exam or other unrelated tests. 

Diagnosis of Fibroids

Ultrasonography sound waves are used for creating the uterus and other pelvic organs picture.

Hysteroscopy device, the hysteroscope is inserted vaginally to see the inside of the uterus and cervix. 

Hysterosalpingography, an X-ray test detecting abnormal changes of the uterus and fallopian tubes. 

Sonohysterography used together with the Ultrasonography to enable specialists to see inside the uterus especially the lining. 

Laparoscopy enable specialists to see the inside of the abdomen. It is inserted through a small cut just below or through the navel. 

Treatment 

When the woman has severe symptoms like heavy menstrual flow that’s painful then the woman need to consult to prevent more problems (anemia). However, when the fibroids are too small, women may not even have symptoms so they don’t need any treatment. 

The only way to get rid of fibroids is by removal. But there are less severe ways that slows down the growth of fibroids or reduce the heavy bleeding. 

Treatment include; 
  • Drugs to control heavy bleeding
  • Birth control pills and other types of hormonal birth control methods
  • Gonadotropin-releasing hormone to shrink the fibroids and can reduce bleeding.
  • Progestin

Ovarian cyst

During or after ovulation the surface of a woman’s ovary can develop sacs called ovarian cyst that holds a maturing ovum/ egg. After the egg is released the sac usually goes away. However, the egg swells up with fluid if the egg is not released or if the sac closes up after the release of the egg. 

It is only when the cyst enlarges that it can twist, rupture, or bleed causing severe pain. otherwise, there are no symptoms and sometimes they can go away without treatment. 

Symptoms of Ovarian Cysts

Symptoms are only experienced by women who have large cysts. And these include;

  • Lower belly pain during your menstrual cycle.
  • Delayed menstrual period
  • Bleeding vaginally when you are not on your periods. 
  • Cysts rupturing as a result of twisting or break open 
  • severe pain
  • nausea and vomiting.
  • Pain during or after sex.

Types of Dysmenorrhea

Primary dysmenorrhea

Some girls experience primary dysmenorrhea as soon as she starts having menstrual periods. the women with primary dysmenorrhea only experience mild pain during their periods and most often their pain is reduced with age. This kind of menstrual cramps can also improve when a woman falls pregnant. 

The secondary dysmenorrhea

Secondary dysmenorrhea begins later in life as a result of reproductive system disorder. Patients with secondary dysmenorrhea complain of their pain getting worse, rather than getting better, as they grow older. 

It is said that women with secondary dysmenorrhea have periods pain before their period starts and the pain can persist after the period end. 

How can dysmenorrhea be treated?

There are many ways in which women ease their periods pain ranging from homemade care to severe procedures in the western medicines. Women must definitely consult with healthcare professionals when the pain keeps persisting with severe symptoms like heavier bleeding than what the woman is used to. 

Moreover, when more symptoms are experienced like fever, chills, and body aches then the woman must know that homemade remedy is not sufficient. 

Various treatment of Menstrual pain

Home Remedies

  • the pelvic heating pad
  • back and lower abdomen massage 
  • forming a habit of exercise, 3 to 4 times a week. 
  • Thiamine (100 mg daily)
  • vegetarian diet
  • Low-fat diet 
  • Calcium (1,200 mg daily)

Medications for Menstrual Pain

Since the menstrual cramps and pain results from inflammation and scarring, women will need to go for the anti-inflammatory medication. These are known to block prostaglandins and thus relieving the pain.  And there a few over-the-counter anti-inflammatory drugs;

  • Ibuprofen (Advil, Motrin), 
  • ketoprofen (Orudis), 
  • and naproxen (Aleve, Naprosyn)

moreover, patients are allowed to pick one of these at a time making sure they take the brand that works best for them. Caution must be ensued while taking these type of drugs as they are highly acidic and can be harsh on the stomach and intestines. 

Sadly, patients with pre-existing ulcers or kidney problems CANNOT and must not use anti-inflammatory drugs. Moreover, women must ensure they don’t take these drugs in an empty stomach to avoid the corroding the stomach wall causing ulcers. 

Contraceptives 

These are made of synthetic hormones and they are known to suppress ovulation and thus treat dysmenorrhea. The combined oral contraceptive pills are said to reduce the prostaglandin production which then reduce the cramps and blood flow. 

Some literature highlight any form of contraceptives can reduce the pain as all contraceptives are meant to control hormones so there can be a normal balance. So, women can choose which contraceptive work best for them. 

Moreover, it would be a good choice to select newer drugs on the market as most of them were produced with ingredients that are meant to deal with dysmenorrhea. 

The birth control includes; 

  1. those with both estrogen and progestin like; the pill, the patch, and the vaginal ring.
  2.  progestin contraceptives; only the birth control implant and the injection
  3.  The hormonal intrauterine device

Surgery 

This is a severe form of treatment and cannot just be done to any woman with discomfort, or cramps during their menstrual periods. a woman will need to present with these symptoms; fibroids, polyps, ovarian cysts, or endometriosis to be considered for surgery. 

Surgery procedures include; 

  • D&C: for the removal of the uterine polyps.
  • Laparoscopy: for pelvic endometriosis or ovarian cysts treatment.
  • Endometrial ablation: the lining of the uterus is destroyed in this procedure.
  • Hysterectomy: to completely remove the uterus surgically. This is more appropriate for women who already have children and do no plan to conceive. 

Exercise

A study conducted by St Mary’s University concluded that exercising does reduce menstrual cramps with over 78 % of participating women confirming the tangible effect of exercising. Exercising is known to minimize or even curb symptoms associated with dysmenorrhea. (source)

Yoga poses are said to be very effective in keeping heaving cramping to a minimum. However, patients who plan to do the Yoga poses need to consult with a professional to prevent or avoid injuries. Furthermore, other forms of exercises like light cardio and Pilates are said to work too. 

Diet 

Diet can either worsen the menstrual cramps of prevent them. Women need to know how to modify their diet before and during her periods. most review suggested omega-3 fatty acid as good food to eat to curb menstrual cramps. 

Good food for Menstrual cramps 

  • Fish
  • Calcium
  • Vitamin D
  • Diet high in fruits and vegetables as it is packed with lots of minerals and vitamins.  
  • Lots of nuts, fax, and chia seeds as they have a lot of natural fats. 
  • Lean meat and chicken to avoid anemia as good sources of iron and protein.

These are packed with omega-3 fatty acid. Moreover, calcium of vitamin D can also be taken as supplements. 

Foods to avoid

  • Animal fat, meat products especially processed meats (butter, cream, bacon and potato chips, etc.) 
  • Salt to prevent; water retention, bloating, breast swelling and pain
  • Caffeine to avoid fatigue, palpitations and mood swings 
  • Dairy products as they can cause lactose intolerance, cramps and bloating. 

Other Therapy for Menstrual Pain

If all the other treatment doesn’t work, patients could consider using; 

Acupuncture

TENS (transcutaneous electrical neural stimulation) unit. Wearing TENS are known to interferes with pain signals as they travel to the brain. 

Conclusions 

Dysmenorrhea is such a serious problem that is caused by several disorders. If any of those causes like endometriosis, uterine fibroids, etc. are not attended to on time women can become interfile or suffer recurrent miscarriages. 

As such, it is important for women to know when to consult their doctors. And as for the cramps, there are a lot of treatment out there to be used. Wiser women can combine the majority of the treatment in order to stay healthy like, contraceptives, exercise and eating the right diet during their period. 

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