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Dysmenorrhea (Painful Periods)

Period pain or dysmenorrhea is a condition of painful menstrual periods. Menstrual cramps or pain is felt in the abdominal areas and can occur before the menstrual cycle begins and can continue through menses. 

Types of Dysmenorrhea

Primary Dysmenorrhea is painful menses in women with no abnormalities in the pelvic region. Women may experience pain before or at the onset of menstrual periods and the pain persists for 2–3 days. Primary dysmenorrhea is caused by the elevated levels of the hormone prostaglandin produced by the tissues lining the uterus (womb). Prostaglandin triggers the uterine muscles to contract and push the uterus lining (endometrium) out of the body through the vagina. Women who have a high level of prostaglandin will experience intense pain and cramping. 

Secondary Dysmenorrhea is painful menses caused by another gynecologic problem. Some conditions that may cause secondary dysmenorrhea include endometriosis, adenomyosis, or fibroids.

Symptoms of Dysmenorrhea

Some of the commonly observed symptoms are back pain, leg pain, nausea, vomiting, diarrhea, headache, irritability, weakness, and fainting. Your doctor will perform a pelvic examination to identify if there are any other problems associated with menstrual cramps. Blood tests and cervical cultures will confirm if there is any sign of infection. Other diagnostic tests may be required which include MRI scan and an ultrasound scan.

Treatment

If the menstrual cramps are because of the underlying medical conditions, then treating the conditions will help to relieve pain. The conservative approach includes non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and decrease the production of prostaglandins, contraceptive hormones, or a progesterone intrauterine device.

NSAIDs are contraindicated if you have a history of kidney and stomach problems. The other home remedies such as a heating pad to the pelvic area, regular exercises, massage to the back and abdomen, low-fat diet, and intake of certain vitamins and supplements may help to manage menstrual pain.

When these treatments are unsuccessful, surgery may be recommended. Some procedures that may be recommended, depending on the cause of pain and the desire for fertility include:

Excision of Endometriosis: Involves removal of endometriosis lesions, endometriosis cysts of the ovary, and potentially scar tissue (adhesions), which can help restore normal anatomy and surrounding organ function.

Myomectomy (removal of fibroids): The removal of uterine fibroids (benign tumors).  

Hysterectomy: The surgical removal of the entire uterus. This procedure will stop periods. It is not recommended for women who want to have children. 

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