Dysmenorrhoea (Menstrual Cramps)

Dysmenorrhoea is described simply as a pain during menstruation. It is a very common symptom, which is experienced by 45-95 % of females of reproductive age.

Menstrual cramps appear like throbbing, cramping, or dull pains in the lower part of the abdomen. The pain can go to your thighs and the lower back too. Some women with dysmenorrhoea experience loose stools, nausea and vomiting, dizziness, and increased sweating.

Menstrual cramps usually begin at the onset of or just before the menstruation and last about eight hours to three days every month. For some females, it is only an irritable feeling. However, some women experience a severe pain, which affects their daily routines for several days each month.

Classification and causes

Menstrual cramps can be classified as either primary or secondary dysmenorrhoea. A woman with primary dysmenorrhoea has no obvious cause or pathology. However, secondary dysmenorrhoea occurs due to an identifiable condition, which is likely to be responsible, at least in part, for menstrual cramps.

Primary dysmenorrhoea

During menstruation, the lining of your womb (endometrium) secretes a type of natural chemicals known as prostaglandins. They help the muscles of your womb (uterine muscles) contract and shed the endometrium during menstruation. Prostaglandins are responsible for menstrual cramps. Their concentration is high during the first day of your menstruation hence the pain also rises. As menstruation proceeds and the endometrium is shed, the prostaglandin level gradually decreases. Pain usually diminishes as the prostaglandin concentration decreases.

Some health-care professionals believe that severe uterine contractions shrink the blood vessels of the womb. It may starve the womb of nutrients and oxygen, causing menstrual cramps.

Usually, primary dysmenorrhoea starts right after a girl begins having menstrual cycles. It generally gets less painful as women get older. It also can improve after having kids.

Secondary dysmenorrhoea

Secondary dysmenorrhoea occurs because of certain conditions linked with your reproductive system. It usually starts later in your life compared to primary dysmenorrhoea. Menstrual cramps are likely to become worse, instead of better, with time. Secondary dysmenorrhoea generally continues longer than primary dysmenorrhoea. It may start a couple of days before menstruation. The pain can become worse as the menstruation proceeds. It may not disappear after the menstrual period ends.

Secondary dysmenorrhoea can be a result of the following conditions.

Endometriosis

The lining of your womb (endometrium) gets implanted outside the womb in endometriosis. It can usually take place on your ovaries, Fallopian tubes, bladder, or the lining of your pelvis. During your menstruation, these implanted tissues secrete prostaglandins, shed, and bleed according to the hormonal changes. Therefore, it can lead to pain, mainly right around your menstruation. Adhesions (scar tissue) may develop on the implanted tissues in which the bleeding occurs. They can result in internal organs to stick with each other, worsening the pain.

Adenomyosis

In adenomyosis, the endometrium starts to grow and spread into the muscles of the womb (uterine muscles).

Uterine fibroids

Uterine fibroids are non-cancerous growths or tumours, which form inside, on the outside, or in the walls of the womb. Fibroids in the uterine wall can rarely lead to pain.

Pelvic inflammatory disease (PID)

PID is an infection of the reproductive system, which can spread to the pelvis too. It usually occurs due to sexually transmitted bacteria.

Cervical stenosis

Some women may have a narrowed cervix, which obstructs the menstrual blood flow. It triggers the accumulation of the blood in the womb, causing increased pressure hence the pain. Cervical stenosis is a rare cause of dysmenorrhoea.



Related Links:

Dysmenorrhoea: Risk Factors and Diagnosis
How to Treat Dysmenorrhoea?
Do You Have Heavy Periods (Menorrhagia)?
Exercise and Your Menstrual Cycle