Dysmenorrhea, Greek for painful menstruation, is classified as primary (from the beginning and usually lifelong) or secondary (due to some physical cause and usually of later onset). The uterus is a muscle. Like all muscles, it contracts and relaxes. Most uterine contractions are never noticed, but strong ones are painful. During strong contractions, the uterus may contract too strongly or too frequently, causing the blood supply to the uterus to be temporarily cut off. This deprives the muscle of oxygen, causing pain. In addition to painful uterine cramping with menses, women with dysmenorrhea may experience nausea, vomiting, diarrhea, headaches, weakness, and/or fainting. Symptoms may vary in severity from cycle to cycle, but generally continue throughout the reproductive years. Dysmenorrhea can be an incapacitating problem, causing significant disruption in a woman's life each month.
Primary dysmenorrhea is the more common type of dysmenorrhea and is due to the production of prostaglandins. These are natural substances made by cells in the inner lining of the uterus and other parts of the body. The prostaglandins made in the uterus make the uterine muscles contract and help the uterus to shed the lining that has built up during the menstrual cycle. If excessive prostaglandins are produced, the woman may have excessive pain or dysmenorrhea with her menstrual cycle. Prostaglandins can also cause headaches, nausea, vomiting and diarrhea.
The nutritional therapy for primary dysmenorrhea includes taking the bad fats out of the diet which are precursors to prostaglandins and getting enough of the good fats. Essential fatty acids Omega 3 and Omega 6 have been shown to be deficient in women who experience dysmenorrhea. Adding these fats and avoiding saturated and trans fats will help in addition to a well balanced diet with an adequate intake of calcium, magnesium and B complex.
Prostaglandin production can be decreased with over-the-counter, non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen sodium, or similar drugs that are stronger and available only by prescription. These drugs are generally well tolerated, although they can upset the stomach and are best taken with a small amount of food. Contraindications to the use of NSAIDs include pregnancy, ulcers, asthma and known allergy to this type of drug.
Hormonal alteration of the menstrual cycle is usually accomplished by taking oral contraceptives (OC). OC's prevent ovulation, decrease the thickness of the uterine lining (endometrium) and as a result, fewer prostaglandins are made. However, alterations should only be attempted if nutritional and exercise is not enough to reduce pain.
Secondary dysmenorrhea is defined as menstrual pain due to pelvic pathology. Secondary dysmenorrhea usually occurs after a woman has had normal menstrual periods for some time. It differs from primary dysmenorrhea in that the pain is caused by an abnormality or disease of the uterus, tubes or ovaries.
The pain may be similar to menstrual cramps, but often lasts longer than the menses, and may also occur at other times of the month.
The most common causes are infection, adenomyosis (benign growths in the uterine walls), endometriosis (tissue from the lining of the uterus implants outside the uterus) and adhesions (scarring or adherence of two surfaces). Treatment of secondary dysmenorrhea depends on finding the cause and treating it appropriately. Medical and/or surgical treatment may be needed.
[b:dbc6c9a328]FINDING THE CAUSE[/b:dbc6c9a328]
Is your menstrual pain caused by normal prostaglandins (primary dysmenorrhea), or an acquired problem requiring treatment (secondary dysmenorrhea)? Before your health care provider can answer this question, he or she may need to ask many questions focusing on your menstrual cycle and reproductive history do a pelvic exam and sometimes order special tests.
The American College of Obstetricians and Gynecologists (January, 1995). Gynecologic Problems: Dysmenorrhea. Washington, D.C.: ACOG.
Hatcher, R.A., Trussel, J., and Stewart, F., et al. Contraceptive Technology - 1998, (17th ed.). New York: Ardent Media.
Havens, C.S., Sullivan, N.D., and Tilton, P. (1996). Manual of Outpatient Gynecology, (3rd ed.). Boston: Little, Brown and Company.[/size:dbc6c9a328]