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DYSMENORRHEA-Painful monthly cycles

Menstrual cramps (dysmenorrhea) are dull, throbbing or cramping pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods. For some women, the discomfort is merely annoying. For others, it can be severe enough to interfere with everyday activities for a few days every month. Menstrual cramps may be caused by identifiable problems, such as endometriosis or uterine fibroids. Treating the underlying cause is key to reducing the pain. Menstrual cramps that aren't caused by some underlying condition tend to lessen with age and often disappear once a woman has given birth.During menses, your uterus contracts to help expel its lining. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more severe menstrual cramps.

Symptoms of menstrual cramps include:

  • Dull, throbbing or cramping pain in your lower abdomen
  • Pain that radiates to your lower back and thighs

Some women also experience: Nausea and vomiting,loose stools, sweating, dizziness.

Menstrual cramps also may be caused by:

  • Endometriosis. In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, your fallopian tubes, ovaries.
  • Uterine fibroids. These noncancerous growths in the wall of the uterus rarely may be the cause of pain.
  • Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.
  • Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
  • Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.
  • If you've started menstruating within the past few years and are experiencing cramps, chances are your menstrual pain is not a cause for concern. However, if menstrual cramps disrupt your life for several days a month or if you're older and just started experiencing severe menstrual cramps, please make an appointment with us, so that we can work with you to investigate causes and plan treatment.
  • Possible tests:Ultrasound. This painless test uses sound waves to visualize internal organs. It is often used to check for abnormalities in the uterus, cervix and fallopian tubes. Rarely we use--

    • Hysteroscopy. In this procedure, your doctor inserts a thin, lighted tube through your vagina and cervix into your uterus. The hysteroscope works like a tiny telescope, allowing your doctor to look through it to check for such things as fibroids or polyps.
    • Laparoscopy. In this outpatient surgical procedure, your doctor views your abdominal cavity by making tiny incisions in your abdomen and inserting a fiber-optic tube with a small camera lens. Laparoscopy can check for certain conditions, such as endometriosis, adhesions, fibroids, ovarian cysts and ectopic pregnancy.
  • Treatments and drugsnd:
    • NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be helpful in relieving the pain of menstrual cramps. Your doctor may initially suggest taking over-the-counter NSAIDs, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve), at regular doses starting the day before you expect your period to begin. Prescription NSAIDs, such as mefenamic acid (Ponstel), are also available.
    • Hormonal birth control. Oral birth control pills contain hormones that prevent ovulation and reduce the severity of menstrual cramps. These hormones can also be delivered in several other forms: an injection, a patch you wear on your skin, an implant placed under the skin of your arm or a flexible ring that you insert into your vagina.
    • Surgery. If your menstrual cramps are caused by an underlying disorder, such as endometriosis or fibroids, the surgical removal of the abnormal tissue may help reduce your symptoms.

    Lifestyle and home remedies: Soaking in a hot bath or using a heating pad on your lower abdomen appears to be just as effective as over-the-counter pain medication for relieving menstrual cramps.

    Alternative therapeutic approaches to menstrual cramps include:

    • Exercise. Studies have found that physical activity may ease the pain of menstrual cramps.
    • Acupuncture. Acupuncture has been used in China to relieve pain for more than 2,000 years. Some studies have found that acupuncture effectively relieves menstrual cramps.
    • Transcutaneous electrical nerve stimulation (TENS). A TENS device raises the threshold for pain signals and stimulates the release of endorphins, your body's natural painkillers. In studies, TENS has been found more effective than placebo in relieving the pain associated with menstrual cramps.
    • Dietary supplements. A number of studies have indicated that vitamin E, omega-3 fatty acids, vitamin B1 (thiamine), vitamin B-6 and magnesium supplements may effectively reduce menstrual cramps
    • We also use a local physical therapy group called womanology.com—who can evaluate and treat many pelvic conditions with us.

     

    © Copyright 2012, Mary J. Kotob, MD, FACOG. All rights reserved.
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