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Primary & Secondary Dysmenorrhea

August 18, 2010

Menstrual cramps seem to be part and parcel of the experience of menses for more than 50% of women. The cramps can range from mild and barely noticeable all the way to "in bed and on pain medication" for several days. Since menstrual cramps don't usually begin until ovulation happens, young girls may not experience cramping with their periods for some time after menarche.

Dysmenorrhea, or menstrual cramps, come in two varieties, primary and secondary. Primary dysmenorrhea means there is no gynecological problem causing the cramping and secondary dysmenorrhea means there is some condition usually associated with the woman's reproductive system that contributes to the pain she is experiencing.

What Causes Cramping?

Menstrual cramps are the result of uterine contractions necessary to expel the endometrium (uterine lining) when there is no fertilized egg to implant and grow into a baby. The contractions occur as a response to the release of prostaglandins and other hormones produced in the body to slough off the unnecessary nesting material. The severity of menstrual cramps can sometimes be attributed to the levels of prostaglandins in the woman's body, as well as the fact that when the lining is released it can break down in larger pieces of tissue which can cause pain as they go through the cervix - especially if the cervical canal is narrow. Another factor that can affect cramping is the backwards tilting of the uterus, called a retroverted uterus.

Other causes of cramping include a lack of exercise. Being sedentary is a contributor to pain during menstruation. Stress, particularly emotional stress, can also increase the pain and discomfort of menstruation for many women. Emotional stress causes a release of hormones that contribute to cramping.

The Symptoms Associated with Menstrual Cramps

The symptoms associated with menstrual cramps are common to most women. Low back pain and pelvic and lower abdominal pain that is either a dull ache or intense discomfort that usually begins just before the period arrives. It peaks in the first 24 hours and then begin to subside about a day or two later. Headache and nausea (in some cases to the point of vomiting) sometimes accompanies the cramps. Since prostaglandins are found in both the uterus and intestinal track, they can cause either constipation or diarrhea along with the uterine contractions. Some women find they have to pee more often as well.

Dealing With the Discomfort of Primary Dysmenorrhea

Primary dysmenorrhea is best treated with adequate rest and sleep, as well as exercise. Walking has been shown to be very effective in helping dispel cramping due to menses. An abdominal massage, yoga, or sex can help as well. A heating pad relaxes the muscles in the abdomen and may help to relieve pain. Acetaminophen or aspirin can help relieve minor cramps and NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen or naproxen, lower the production of prostaglin, lessening the effect of cramping. In some cases a doctor may prescribe oral contraceptives in a low doses to help control the production of prostaglandins. The contraceptive pills have estrogen and progestin which balances the effect of prostaglandins. The use of an IUD that releases small amounts of progestin levonorgestrel into the uterus has been effective. However, an IUD that does not contain hormones can make cramping even worse.

It Could Be Something Serious

Secondary dysmenorrhea may be caused by endometriosis, uterine fibroids, adenomyosis (a condition in which the cells of the inner uterine lining invade its wall), pelvic inflammatory disease, adhesions or an IUD that doesn't have hormones in it. Appropriate treatment will be determined by a doctor who has diagnosed the cause of the cramping.

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