Dysmenorrhoea

Dysmenorrhoea is pain in the lower abdomen, stemming from uterine cramps, during a menstrual period. The condition is called 'primary dysmenorrhoea' when no abnormality causing it is identified and 'secondary dysmenorrhoea' when an underlying gynaecological disorder is found to be the cause.

Secondary dysmenorrhoea causes

• Endometriosis
• A narrow cervical canal (e.g. after treatment for a cervical disorder)
• Fibroids - benign tumours made of muscle and tissue, which grow inside the uterus and are thought to be influenced by the sex hormone oestrogen.
• Adenomyosis (non-cancerous invasion of the muscular wall of the uterus by the uterine lining)
• Inflammation of the fallopian tubes
• Abnormal fibrous attachments (adhesions) between organs

Symptoms
Symptoms of dysmenorrhoea can include:

The lower abdominal pain of dysmenorrhoea may extend into the lower back or into the thighs. It may consist of cramps that come and go or a dull ache that is constant. Generally the pain begins with or shortly before the menstrual flow, peaks after 24 hours and subsides after two days. Pain arising because of inflammation of the fallopian tubes or because of adhesions (where the lining of the tubes, uterus or cervix has stuck together abnormally) may also cause abdominal pain but this is unrelated to menstrual period

Sometimes, dysmenorrhoea is associated with:

• Headache.
• Nausea and vomiting.
• Digestive upsets, such as diarrhoea or constipation.
• Fainting.
• Premenstrual symptoms, such as tender breasts and swollen abdomen, which may continue throughout the period.

The trigger of primary dysmenorrhoea is mysterious
In primary dysmenorrhoea, the uterus works too hard to dislodge its lining (endometrium) and the resulting contractions and associated ischaemia (hampered blood flow) cause pain. The hormone-like compounds that prompt these uterine contractions are prostaglandins. It seems that a woman with dysmenorrhoea has comparatively high levels of prostaglandins, which cause harder than normal uterine contractions. The reasons for the increased prostaglandins are unknown.

Treatment for primary dysmenorrhoea
A woman with dysmenorrhoea needs a thorough medical examination to ensure that her period pain isn't caused by some primary gynaecological problem.

Treatment options for primary dysmenorrhoea include:

• Bed rest during the first day or so of the menstrual period.
• Heat treatment, such as hot water bottles held across the abdomen.
• Pain-killing drugs, such as paracetamol.
• Drugs that inhibit prostaglandins, such as ibuprofen.
• Regular exercise and attention to overall physical fitness.
• Relaxation techniques.

The oral combined contraceptive pill, which usually eliminates period pain by suppressing ovulation.

Treatment for secondary dysmenorrhoea
Treatment depends on the cause, but may include:

• Medications - such as anti-inflammatories or the oral combined contraceptive pill.
• Surgery - is occasionally used to treat fibroids or endometriosis.