Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain. While the pain may be only mild for some women, others experience severe discomfort that can significantly interfere with everyday activities for several days each month. It is a menace that must be managed to minimize the loss incurred by women missing work or study time.

Classification

Dysmenorrhea is considered to be "primary" when there is no specific abnormality, and "secondary" when the pain is caused by an underlying gynecological problem.

Primary dysmenorrhea usually begins within the first 6 months after menarche once a regular ovulatory cycle has been established.

Secondary dysmenorrhea is rare and may be due to:

• endometriosis,

• adenomyosis

• PID (pelvic inflammatory diseases)

• uterine fibroid.

• The presence of a copper IUD (Intrauterine device)

• Leiomyomata (fibroids)

• Tubo-ovarian abscess

• Ovarian torsion

• Ovarian cysts

Dysmenorrhea can be further classified as:

1. Spasmodic- manifests as cramping pains generally most pronounced on the first and second day of menstruation
2. Congestive-manifests as increasing pelvic discomfort and pain a few days before menses begin
3. Membranous- here the endometrium is shed as a cast at time of menstruation and at this very moment painful uterine cramps accompany it.

PATHOPHYSIOLOGY (Why it happens)

During menstruation, sloughing endometrial cells release prostaglandins. It is these prostaglandisn E₂ and F₂ alpha which cause vasoconstriction and myometrial contractions. However, the level of prostaglandins does not seem to have anything to do with how strong a woman's cramps are. Some women have high levels of prostaglandins and no cramps, whereas other women with low levels have severe cramps. This is why experts assume that other factors such as genetics, stress, and different body types play a role in causing dysmenorrhea.

Signs and symptoms

The main and only symptom is usually lower abdominal/pelvic pain that begins with onset of menses and lasts 8-72 hours.

However, in some women and girls, uterine cramping may be accompanied by other symptoms such as;

• giddiness

• syncope and fainting.

• Low back pain

• Medial/anterior thigh pain

• Headache Diarrhea

• Nausea/vomiting

TREATMENT

NSAIDS

Most women respond to anti-inflammatory drugs like mefenamic acid and naproxane.

ANALGESICS

Simple analgesics, such as aspirin and acetaminophen, may also be useful, especially when NSAIDs are contraindicated.

Leukotriene-receptor antagonist

montelukast, a leukotriene-receptor antagonist is also known to give relief.

DIETARY SUPPLEMENTS

Certain dietary supplements may be effective, Thiamine, fish oil, pyridoxine, magnesium, vitamin E, increasing fiber, calcium, and complex carbohydrates, cutting fat, red meat, dairy products, caffeine, salt, and sugar.

ORAL CONTRACEPTIVES

Oral contraceptives, which block monthly ovulation and may decrease menstrual flow, may also relieve symptoms.

OTHER REMEDIES

• Pulsed electromagnetic field therapy (Allay patch)- a zapper in your undies that periodically fires mild current through the abdomen

• direct application of heat is a common effective strategy.

• Simply changing the position of the body can help ease cramps. The simplest technique is assuming the fetal position, with knees pulled up to the chest while hugging a heating pad or pillow to the abdomen.

• Yoga

• Aromatherapy and massage.

• Acupuncture

• Exercise may be a way to reduce the pain of menstrual cramps through the brain's production of endorphins, the body's own painkillers.

• orgasm can make a woman feel more comfortable by releasing tension in the pelvic muscles.