Dysmenorrhea is the pain that precedes, accompanies or follows menstruation. The cause of this pain is not well known. The clinical and gynecological examination must be accurate, additional examinations are required depending on the case and the diagnostic orientation, but in most cases this sensation is not so disabling as to require invasive intervention. Often people go to the pharmacy looking for a cure that can relieve this dull and acute pain, and the answer lies in the classic non-steroidal anti- inflammatory drugs that act in the re-uptake of the accumulation of inflammatory cyclooxygenases (prostaglandins). 

In fact, one of the most accredited causes in the scientific world seems to be that dysmenorrhea is caused by excessive concentrations of prostaglandins , hormones that cause the uterus to contract during menstruation and childbirth. The pain is explained by a release of these hormones during the detachment of the endometrium (the membrane that lines the uterus) during the period of menstruation, causing the uterus to contract and reduce its blood supply.

Factors that can further aggravate the pain associated with primary dysmenorrhea include tilting the uterus backward (uterus retroversion) rather than forward, more intense or irregular periods, lack of exercise, psychological or social stress, smoking , alcohol consumption, overweight, family history of dysmenorrhea and onset of menstruation before age 12.

Secondary dysmenorrhea can result from a number of conditions, including the following:

• adenomyosis: the tissue that lines the uterus (called the endometrium) begins to grow within its muscle walls;
• endometriosis: fragments of the endometrial wall exit the uterus and implant on other organs of the pelvis;
• fibroids – benign tumors that appear or are attached to the uterine wall;
• sexually transmitted infection (STI);
• the use of an intrauterine device (method of contraception);
• salpingitis – an infection that mainly affects the fallopian tubes but can also affect the ovaries, uterus and cervix;
• ovarian cancer or cyst.  

Symptoms of dysmenorrhea

The main symptom of dysmenorrhea is the presence of pain , which appears in the lower abdomen during menstruation and can also be felt in the hips, lower back or thighs. Other symptoms may appear, including nausea, vomiting, diarrhea, dizziness, headache, or fatigue.

For most women, the pain usually begins shortly before or at the beginning of the period, peaks around 24 hours after the bleeding begins, and begins to go away after 2 to 3 days. Clots or bloody pieces of tissue from the lining of the uterus can be expelled from the uterus, causing pain.

The pain of dysmenorrhea can be spasmodic (severe pelvic cramps that occur at the onset of menstruation) or congestive (dull, persistent pain). Symptoms of secondary dysmenorrhea often appear earlier than those of primary dysmenorrhea in the menstrual cycle and usually persist longer.

In 5-15% of cases, the pain experienced in women with primary dysmenorrhea is severe enough to interfere with their daily activities and may be the cause of an absence from school or work.

Treatment and prevention

Your doctor may prescribe medications or other remedies depending on the cause of the dysmenorrhea.

Primary dysmenorrhea is usually treated with pain medication. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen ( Buscofen ) and naproxen provide relief for many women.

Some doctors may prescribe hormone supplements. Oral contraceptives can help reduce the severity of symptoms. Nausea and vomiting can be treated with anti-nausea medications (antiemetics), but these symptoms usually go away without treatment when the cramps have subsided. Implantable contraceptives and progesterone-based intrauterine devices that release a small amount of the hormone progesterone have also been shown to be very helpful in relieving pain.

Other non-medical measures can help relieve pain caused by dysmenorrhea:

• doing light exercises, such as stretching, walking, or cycling (exercise can improve blood supply and reduce pelvic pain);
• yoga;
• place a hot water bottle on the abdomen or lower back;
• getting plenty of rest and avoiding stressful situations as your period approaches;
• take a warm bath.

Endometriosis and painful menstruation

Menstrual pains are common to many women, however, in some cases, they can hide other problems. If the pain persists and no treatment, not even pharmacological, seems to be able to relieve it, you should speak to a doctor. In fact, it can be a sign of a condition such as endometriosis. This gynecological disease is characterized by the presence of fragments of the uterine lining located outside the uterus (rectum, bladder, intestine, ovary). 

These lesions, called endometriotic lesions, become inflamed during menstrual cycles, which can cause severe pelvic pain. Diagnosing endometriosis is not straightforward, leading some patients to discover the disease by accident. Today it affects 1 in 10 women. 

As soon as dysmenorrhea occurs in a disabling way, it is always necessary to go to the doctor, so that we can think of endometriosis in order to be able to diagnose it as soon as possible and implement an early treatment.