Dysmenorrhea

The pain associated with menstrual cramping is called dysmenorrhea. There are two types of dysmenorrhea, primary and secondary:

• Primary dysmenorrhea is menstrual cramping that happens before or during a monthly period. The pain is usually mild, but can be severe for some teen girls and women.
• Secondary dysmenorrhea is cramping pain that develops because of some other condition, such as endometriosis or ovarian tumors.

Any teen girl or woman can develop dysmenorrhea, but factors that may predispose her include:

• Smoking
• Alcohol (alcohol tends to prolong menstrual pain)
• Being overweight
• Starting menstruation before age 11

Menstrual cramping is dull, throbbing, or squeezing pains in the lower abdomen before or during menstruation. For one girl, these aches may be mild and no cause for concern. For another, the discomfort may be so severe she has to stay home from work or school.

Every teen girl and woman experiences dysmenorrhea differently. Some common symptoms include:

• Dull, throbbing, or cramping pain in her lower abdomen
• Pain that radiates to her lower back and thighs
• Nausea and vomiting
• Loose stools
• Sweating
• Dizziness
• Headaches

Primary dysmenorrhea happens before or during a monthly period. During menstruation, a hormone called prostaglandin causes the blood vessels and muscles of the uterus to contract and shed its lining. The level of prostaglandin is highest on the first day of menstruation and decreases as the lining is shed. This is why period pain lessens over time. Period pain may improve with age or after giving birth. Some teen girls and young women experience more severe pain during menstruation.

Secondary amenorrhea is caused by other conditions such as:

• Endometriosis
• Pelvic inflammatory disease (PID)
• Uterine fibroids
• Abnormal pregnancy (i.e., miscarriage, ectopic)
• Infection, tumors, or other growths in the pelvic cavity
• Cervical stenosis

When you or your daughter suspects dysmenorrhea, a healthcare provider will take a complete medical history. Dysmenorrhea can often be diagnosed without a pelvic examination. Diagnostic tests for dysmenorrhea include:

• Ultrasound
• Magnetic resonance imaging (MRI)
• Laparoscopy, a minor surgical procedure in which a physician looks inside the pelvic cavity with a small camera

Medications are often used to treat period pain associated with primary dysmenorrhea. Certain medications reduce prostaglandin and can lessen their effects. These pain relievers are called nonsteroidal anti-inflammatory medications, or NSAIDs, and can reduce the pain associated with menstruation. Women with certain conditions cannot take NSAIDs and should speak with their health care provider to find the best pain reliever.

Many hormonal treatments make periods lighter and less painful or suppress periods completely. Most of these hormonal treatments are birth control methods and include both estrogen and progesterone, or only progesterone. Birth control pills, the patch, or the vaginal ring may be used to treat primary dysmenorrhea. The intrauterine device (IUD) is another type of hormonal birth control that may lessen menstrual bleeding and, for some women, may stop bleeding completely.

Other ways of managing menstrual pain include:

• Acupuncture or acupressure
• Nerve-stimulation therapies
• Physical therapy
• Relaxation exercises, such as meditation or yoga
• Biofeedback
• Aerobic exercise
• Heat applied to the abdomen
• Getting enough sleep

Treatment of secondary dysmenorrhea varies by condition but birth control methods and pain relievers such as NSAIDs may be recommended.

At the Division of Gynecology and Reproductive Endocrinology and Polycystic Ovary Syndrome (PCOS) Program at Boston Children's Hospital, we understand the seriousness of severe menstrual cramps. Our experienced physicians will work with your daughter to provide an accurate diagnosis and treatment of the problem underlying her dysmenorrhea.

The Center for Young Women's Health provides extensive and easy to access information for girls with questions about their menstrual cycles.

• Puberty and Your Menstrual Cycle: A Guide for Teens