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Many women experience lower abdominal cramping shortly before and during their menstrual period. The pain is usually mild and does not interfere with a woman’s normal activities.

Painful menstruation or dysmenorrhea is the most common complaint of patients visiting gynecologists. Many women experience mild discomfort during their menstrual periods, but the term "dysmenorrhea" is reserved for when the pain prevents normal activity and requires medication.

Dysmenorrhea is defined as severe, painful cramping centered in the lower abdomen that occurs with menstruation. Other symptoms may occur just before or during menses, they include:
1. Backache
2. Pulling sensation in the inner thighs
3. Headache
4. Nausea
5. Vomiting
6. Diarrhea
7. Dizziness (rare)
8. Sweating
9. Tachycardia (fast heartbeat)
10. Tremulousness (shakiness)

Unfortunately, dysmenorrhea is common and often leads to decreased productivity at school and work.

Dysmenorrhea is classified as primary or secondary. Primary dysmenorrhea usually starts one to two years after a female’s first period. It is thought to be due to prostaglandins, a group of chemicals made by the tissue that lines the uterus.

The uterus is a muscular organ that can contract and relax. Prostaglandins cause the uterus to contract and expel menstrual flow. When the uterus contracts it may produce a cramping pain. Most of the prostaglandin release is during the first 48 hours of menstruation. This is why the pain is most intense during the first few days of the menstrual period and then lessens, usually lasting 1 to 3 days. Women with painful menstrual periods make larger amounts of prostaglandins than women who do not have these symptoms.

Secondary dysmenorrhea refers to painful menstrual periods due to other conditions. It is most often seen in women over 20 years of age. With secondary dysmenorrhea, the pain may begin several days before a woman’s period, may worsen during a menstrual period, and may even persist after a woman’s period ends.

Some of the common causes of secondary dysmenorrhea are:
1. Endometriosis - a condition where the tissue that usually only lines the inside of the uterus is found growing outside the uterus. This tissue responds to monthly hormonal changes wherever it is located.
2. Fibroid - non-cancerous tumors, or growths, in the uterus.
3. Pelvic inflammatory disease - a bacterial infection of the uterus that sometimes spreads to the fallopian tubes and ovaries. Most cases are sexually transmitted.
4. Cervical stenosis - narrowing of the cervix as it leads to the uterus.
5. Intrauterine device - a small contraceptive device that is placed in the uterus.

Dysmenorrhea is diagnosed with various exams and tests. The healthcare provider will first need to take a detailed patient history, focusing on the past details of the menstrual pain.

The healthcare provider will usually ask the following types of questions:
1. Where is the pain?
2. When does the pain occur?
3. Is the pain sharp or dull?
4. Is the pain constant or does it come and go?
5. Is the pain local or does it radiate (move to other parts of the abdomen)?
6. Does anything make the pain worse?
7. Does any activity or medication lessen the pain?
8. Do any over-the-counter pain medications relieve the pain?
9. What effect do birth control pills have on the pain?
10. Is the pain getting worse over time?
11. When did you get your first period?
12. Have your periods been regular?
13. Have you ever missed school, work, or another important engagement because of menstrual cramps?

The healthcare provider will then perform a physical exam, including a pelvic exam to see if there are possible abnormalities causing the pain. A Pap smear, blood tests and cultures may be taken. In addition, an ultrasound of the pelvis may be done to check for other abnormalities. The healthcare provider may suggest that the patient keep a menstrual diary by charting the length and frequency of the patient’s periods to establish what is normal for the patient.

If the menstrual pain is not relieved with medication or if a secondary cause of dysmenorrhea is suspected, a surgical procedure called laparoscopy may need to be performed. Laparoscopy allows the healthcare provider to look directly inside the body. The procedure is usually done with general anesthesia and requires admission to either an outpatient surgery facility or the hospital. During laparoscopy, the healthcare provider can look for problems that may be causing the pain, such as adhesions, endometriosis or a cyst. Bear in mind that despite careful evaluation, the healthcare provider is often unable to find a cause for the dysmenorrhea. However, very effective treatment is available for painful menstrual periods.

Over the Counter Medications for relief

Dysmenorrhea is often relieved by over-the-counter pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs block the production of the prostaglandins that cause menstrual cramps. Examples of NSAIDs that are very effective for the treatment of dysmenorrhea include ibuprofen and naproxen.

NSAIDs work best when taken at the first sign of the menstrual period or pain. NSAIDs should be taken around the clock as directed usually for one or two days. Nausea and heartburn are possible side effects that may be reduced by taking NSAIDs with food or milk.

Women with gastrointestinal ulcers, aspirin allergy/sensitivity, bleeding disorders, or liver damage should not take NSAIDs. If the pain is unrelieved by the first medication tried, the healthcare provider will likely try a different medication. A 4- to 6- month course of therapy should be attempted. If the pain is severe, a stronger, prescription drug may be needed.