Dysmenorrhea

Dysmenorrhea (or dysmenorrhoea) is a gynecological medical condition characterized by severe uterine pain during menstruation. While most women experience minor pain during menstruation, dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities, or requiremedication.
Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.
Secondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying diease,disorder or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these is detected.

Classification

Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis Other causes include adenomyosis ovarian cyst, and pelvic congestions. The presence of a copper IUD can also cause dysmenorrhea.

Signs and symptoms

The main symptom of dysmenorrhea is pain concentrated in the lower abdomen in the umbilical region or the suprapubic region of the abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thigh and lower back. Other symptoms may include nausea andvomiting, diarhea orconstipation,headche , hypersensitivity to sound, light, smell and touch,fainting, and fatigue. Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea, because the birth control pills stop ovulation from occurring.

Pathophysiology

During a woman's menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovumi s not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus shed.
Molecular compounds called prostaglandin are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents. Release of prostaglandin and other inflammatory mediators in the uterus cause the uterus to contract. These substances are thought to be a major factor in primary dysmenorrhea. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through thecervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps" experienced during menstruation.
Compared with other women, females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions

Treatments

Nutritional

Several nutritional suplements have been indicated as effective in treating dysmenorrhea, including OMEGA-3
fatty acids,magnesium, vitamin E.

NSAID

 nOn-steroidal anti inflammatory drug (NSAIDs) are effective in relieving the pain of primary dysmenorrhea.