From Wikipedia, the free encyclopedia
dysmenorrhoea) is a medical condition
characterized by severe uterine pain
during menstruation. While most women experience
minor pain during menstruation, dysmenorrhea is diagnosed when the
pain is so severe as to limit normal activities, or require medication.
Dysmenorrhea can feature different kinds of pain, including
sharp, throbbing, dull, nauseating, burning, or shooting pain.
Dysmenorrhea may precede menstruation by several days or may
accompany it, and it usually subsides as menstruation tapers off.
Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagia.
Secondary dysmenorrhea is diagnosed when symptoms are
attributable to an underlying disease, disorder, or structural abnormality either
within or outside the uterus. Primary dysmenorrhea is diagnosed
when none of these is detected.
During a woman's menstrual cycle, the endometrium thickens in preparation for
After ovulation, if the
ovum is not fertilized and there is no
pregnancy, the built-up uterine tissue is not needed and thus
Molecular compounds called prostaglandins are released during
menstruation, due to the destruction of the endometrial cells, and
the resultant release of their contents.
Release of prostaglandins and other inflammatory
mediators in the uterus cause
the uterus to contract. These substances are thought to be a major
factor in primary dysmenorrhea. When
the uterine muscles contract, they constrict the blood supply to the
tissue of the endometrium, which, in turn, breaks down and dies.
These uterine contractions continue as they squeeze the old, dead
endometrial tissue through the cervix and out of the body through the vagina. These contractions, and
the resulting temporary oxygen deprivation to nearby tissues, are
responsible for the pain or "cramps" experienced during
Compared with other women, females with primary dysmenorrhea
have increased activity of the uterine muscle with increased
contractility and increased frequency of contractions.
The main symptom of dysmenorrhea is pain concentrated in the
lower abdomen, in the
umbilical region or the suprapubic region of the abdomen. It is
also commonly felt in the right or left abdomen. It may radiate to
the thighs and lower back. Other symptoms may
include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation,
hypersensitivity to sound, light, smell and touch, fainting,
and fatigue. Symptoms of dysmenorrhea
often begin immediately following ovulation and can last until the
end of menstruation. This is because dysmenorrhea is often
associated with changes in hormonal levels in the body that occur
with ovulation. The use of certain types of birth control pills can
prevent the symptoms of dysmenorrhea, because the birth control
pills stop ovulation from occurring.
In a systematic review, an age of less than 30 years, a low body mass
index, smoking, early menarche (< 12 years),
cycles, heavy menstrual flow, nulliparity, premenstrual syndrome, sterilization,
clinically suspected pelvic inflammatory
abuse, and psychological symptoms were associated with
In one research study using MRI, visible features of the uterus were
compared in dysmenorrheic and eumenorrheic (normal) participants.
The study concluded that in dysmenorrheic patients, visible
features on cycle days 1-3 correlated with the degree of pain, and
differed significantly from the control group.
Several nutritional supplements have been indicated as
effective in treating dysmenorrhea, including omega-3 fatty
acids, magnesium, vitamin E, zinc, and thiamine (vitamin B1).
Research indicates that one mechanism underlying dysmenorrhea is
a disturbed balance between anti-inflammatory, vasodilator eicosanoids derived from omega-3 fatty acids, and proinflammatory, vasoconstrictor
eicosanoids derived from omega-6 fatty
Several studies have indicated that intake of omega-3 fatty acids
can reverse the symptoms of dysmenorrhea, by decreasing the amount
of omega-6 FA in cell membranes.  The
richest dietary source of omega-3 fatty acids is found in flax
Oral intake of magnesium has also been indicated
in providing relief: two double-blind, placebo-controlled studies
demonstrated a positive therapeutic effect of magnesium on
dysmenorrhea.  A
randomized, double-blind, controlled trial demonstrated that oral
intake of vitamin E relieves the pain of primary dysmenorrhea and
reduces blood loss. A
review of case histories indicated that zinc, in 1 to 3 30-milligram doses given daily for one to four
days prior to onset of menses, prevents essentially all to all
warning of menses and all menstrual cramping.
Intake of thiamine (vitamin B1) was demonstrated to
provide "curative" relief in 87% of females experiencing
dysmenorrhea, in a controlled study.
Non-steroidal anti-inflammatory drugs
(NSAIDs) are effective in relieving the pain of primary
NSAIDs can have side effects of nausea, dyspepsia, peptic ulcer, and
Patients who cannot take the more common NSAIDs, or for whom they
are not effective, may be prescribed a COX-2 inhibitor.
One study indicated that conventional therapy with NSAIDs "provides
symptomatic relief but has increasing adverse effects with
another indicated that long-term use of NSAIDs has "severe adverse
Although use of hormonal contraception can
improve or relieve symptoms of primary dysmenorrhea,
a 2001 systematic review found that no conclusions can be made
about the efficacy of commonly used modern lower dose combined oral
contraceptive pills for primary dysmenorrhea. Norplant and
are also effective, since these methods often induce amenorrhea. The IntraUterine System (Mirena IUD) has been
cited as useful in reducing symptoms of dysmenorrhea.
Several non-drug therapies for dysmenorrhea have been studied,
including behavioral, acupuncture, acupressure, chiropractic
care, and the use of a TENS unit.
Behavioral therapies assume that the physiological process
underlying dysmenorrhea is influenced by environmental and
psychological factors, and that dysmenorrhea can be effectively
treated by physical and cognitive procedures that focus on coping
strategies for the symptoms rather than on changes to the
underlying processes. A 2007 systematic review found some
scientific evidence that behavioral interventions may be effective,
but that the results should be viewed with caution due to poor
quality of the data.
Acupuncture and acupressure are used to treat dysmenorrhea. A
review cited four studies, two of which were patient-blind,
indicating that acupuncture and acupressure were effective.
This review stated that the treatments appear "promising" for
dysmenorrhea, and that the researchers considered further studies
to be justified. Another study indicated that acupuncture "reduced
perception of dysmenorrhea",
still another indicated that adding acupuncture in patients with
dysmenorrhea was associated with improvements in pain and quality of
Although claims have been made for chiropractic care, under the theory that
treating subluxations in the spine may
decrease symptoms, a
2006 systematic review found that overall no evidence suggests that
manipulation is effective for treatment of primary and
Treatment with a transcutaneous
electrical nerve stimulation (TENS) unit, often used for chronic pain, was
indicated as effective in several studies.
One study encouraged providers to try the TENS unit with patients,
on the grounds that they found it to be "non-invasive,
efficient, and easy to use".
A study led by the same researchers reported proof of TENS'
Other medications and
Other medications and herbal therapies have been studied in the
treatment of dysmenorrhea. A 2008 systematic review found promising
evidence for Chinese herbal
medicine for primary dysmenorrhea, but that the evidence was
limited by its poor methodological quality. One
study indicated that two Japanese herbal medicines
provided all of the study participants with complete relief.
A review indicated the effectiveness of use of transdermal nitroglycerin.
A double-blind, controlled study indicated that treatment with an
extract of guava leaf resulted in significant reduction of
In a small double-blind, placebo-controlled study, guaifenesin reduced
primary dysmenorrhea, but the effect was not significant.
One study suggested that vasopressin antagonists with V1(a)
selectivity might be useful in treating a variety of disorders,
A survey in Norway showed
that 14 percent of females between the ages of 20 to 35 experience
symptoms so severe that they stay home from school or work.
Among adolescent girls, dysmenorrhea is the leading cause of
recurrent short-term school absence in this group.
Reports of dysmenorrhea are greatest among individuals in their
late teens and 20s, with reports usually declining with age. One
study indicated that 67.2% of adolescent females
A study of Hispanic
adolescent females indicated a high prevalence and impact in this
Another study indicated that dysmenorrhea was present in 36.4% of
participants, and was significantly associated with lower age and
Childbearing is said to relieve
dysmenorrhea, but this does not always occur. One study indicated
that in nulliparous women with primary
dysmenorrhea, the severity of menstrual pain decreased
significantly after age 40. 
concluded that menstrual problems, including dysmenorrhea, were
more common in females who had been sexually abused.
Secondary dysmenorrhea is dysmenorrhea which is associated with
an existing condition. The most common cause of secondary
dysmenorrhea is endometriosis.
Other causes include leiomyoma,
ovarian cysts, and
The presence of a copper IUD can also cause dysmenorrhea.
In patients with adenomyosis, the levonorgestrel intrauterine system (Mirena) was
observed to provide relief.
- ^ Lethaby A, Augood C, Duckitt K, Farquhar C
(2007). "Nonsteroidal anti-inflammatory drugs for heavy menstrual
bleeding". Cochrane Database Syst Rev (4): CD000400. doi:10.1002/14651858.CD000400.pub2. PMID 17943741.
Wright, Jason and Solange Wyatt. The Washington Manual
Obstetrics and Gynecology Survival Guide. Lippincott Williams
and Wilkins, 2003. ISBN 0-7817-4363-X
Rosenwaks Z, Seegar-Jones G (October
1980). "Menstrual pain: its origin and pathogenesis". J Reprod
Med 25 (4 Suppl): 207–12. PMID 7001019.
- ^ Latthe P, Mignini L, Gray R, Hills R, Khan
K (2006). "Factors predisposing women
to chronic pelvic pain: systematic review". BMJ
332 (7544): 749–55. doi:10.1136/bmj.38748.697465.55. PMID 16484239.
- ^ Kataoka M, Togashi K, Kido A, et
al. (2005). "Dysmenorrhea: evaluation with cine-mode-display
MR imaging--initial experience". Radiology
235 (1): 124–31. doi:10.1148/radiol.2351031283. PMID 15731368.
- ^ Xu L, Liu SL, Zhang JT (2005).
"(-)-Clausenamide potentiates synaptic transmission in the dentate
gyrus of rats". Chirality 17 (5):
239–44. doi:10.1002/chir.20150. PMID 15841477.
Deutch B (1996). "[Painful
menstruation and low intake of n-3 fatty acids]" (in Danish).
Ugeskr. Laeg. 158 (29): 4195–8. PMID 8701537.
Harel Z, Biro FM, Kottenhahn RK,
Rosenthal SL (1996). "Supplementation with omega-3 polyunsaturated
fatty acids in the management of dysmenorrhea in adolescents".
Am. J. Obstet. Gynecol. 174 (4): 1335–8.
doi:10.1016/S0002-9378(96)70681-6. PMID 8623866.
Menstrual discomfort in
Danish women reduced by dietary supplements of omega-3 PUFA and B12
(fish oil or seal oil capsules), ScienceDirect
Prasad K (1997). "Dietary flax seed in
prevention of hypercholesterolemic atherosclerosis".
Atherosclerosis 132 (1): 69–76. doi:10.1016/S0021-9150(97)06110-8. PMID 9247361. http://linkinghub.elsevier.com/retrieve/pii/S0021-9150(97)06110-8.
"Flax seed is the
richest source of omega-3 fatty acid and lignans."
Seifert B, Wagler P, Dartsch S,
Schmidt U, Nieder J (1989). "[Magnesium--a new therapeutic
alternative in primary dysmenorrhea]" (in German). Zentralbl
Gynakol 111 (11): 755–60. PMID 2675496.
Fontana-Klaiber H, Hogg B (1990).
"[Therapeutic effects of magnesium in dysmenorrhea]" (in German).
Schweiz. Rundsch. Med. Prax. 79 (16):
491–4. PMID 2349410.
Ziaei S, Zakeri M, Kazemnejad A
(2005). "A randomised controlled trial of vitamin E in the
treatment of primary dysmenorrhoea". BJOG
112 (4): 466–9. doi:10.1111/j.1471-0528.2004.00495.x. PMID 15777446.
- ^ Eby GA (2007). "Zinc treatment prevents
dysmenorrhea". Med. Hypotheses 69 (2):
297–301. doi:10.1016/j.mehy.2006.12.009. PMID 17289285.
Proctor M, Farquhar C (2006). "Diagnosis and management of
dysmenorrhoea". BMJ 332 (7550):
1134–8. doi:10.1136/bmj.332.7550.1134. PMID 16690671. PMC 1459624. http://www.bmj.com/cgi/content/full/332/7550/1134.
- ^ Andreoli, Thomas E.,
Charles C. J. Carpenter, Robert C. Griggs, and Joseph Loscalzo.
CECIL Essentials of Medicine, 6th ed. Saunders, 2004. ISBN
- ^ Rossi S, editor. Australian Medicines
Handbook 2006. Adelaide: Australian Medicines Handbook; 2006.
- ^ Chantler I, Mitchell D, Fuller A (2008).
"The effect of three cyclo-oxygenase inhibitors on intensity of
primary dysmenorrheic pain". Clin J Pain
24 (1): 39–44. doi:10.1097/AJP.0b013e318156dafc. PMID 18180635.
- ^ Jia W, Wang X, Xu D, Zhao A, Zhang Y
(2006). "Common traditional Chinese medicinal herbs for
dysmenorrhea". Phytother Res 20 (10):
- ^ Ostad SN, Soodi M, Shariffzadeh M,
Khorshidi N, Marzban H (2001). "The effect of fennel
essential oil on uterine contraction as a model for dysmenorrhea,
pharmacology and toxicology study". J Ethnopharmacol
76 (3): 299–304. doi:10.1016/S0378-8741(01)00249-5. PMID 11448553. http://linkinghub.elsevier.com/retrieve/pii/S0378874101002495.
- ^ Archer DF (November 2006).
"Menstrual-cycle-related symptoms: a review of the rationale for
continuous use of oral contraceptives". Contraception
74 (5): 359–66. doi:10.1016/j.contraception.2006.06.003. PMID 17046376.
- ^ Harel Z (December 2006). "Dysmenorrhea in
adolescents and young adults: etiology and management". J
Pediatr Adolesc Gynecol 19 (6): 363–71. doi:10.1016/j.jpag.2006.09.001. PMID 17174824.
Proctor ML, Roberts H, Farquhar CM
(2001). "Combined oral contraceptive pill (OCP) as treatment for
primary dysmenorrhoea". Cochrane Database Syst Rev (4):
CD002120. doi:10.1002/14651858.CD002120. PMID 11687142.
Power J, French R, Cowan F (2007).
"Subdermal implantable contraceptives versus other forms of
reversible contraceptives or other implants as effective methods of
preventing pregnancy". Cochrane Database Syst Rev (3):
CD001326. doi:10.1002/14651858.CD001326.pub2. PMID 17636668.
- ^ Glasier, Anna (2006). "Contraception". in
DeGroot, Leslie J.; Jameson, J. Larry (eds.).
Endocrinology (5th ed.). Philadelphia: Elsevier Saunders.
pp. 2993–3003. ISBN
- ^ Loose, Davis S.; Stancel, George M. (2006).
"Estrogens and Progestins". in Brunton, Laurence L.; Lazo, John S.;
Parker, Keith L. (eds.). Goodman & Gilman's The
Pharmacological Basis of Therapeutics (11th ed.). New York:
McGraw-Hill. pp. 1541–1571. ISBN
- ^ Gupta HP, Singh U, Sinha S (2007).
"Laevonorgestrel intra-uterine system--a revolutionary
intra-uterine device". J Indian Med Assoc
105 (7): 380, 382–5. PMID 18178990.
Proctor ML, Murphy PA, Pattison HM,
Suckling J, Farquhar CM (2007). "Behavioural interventions for
primary and secondary dysmenorrhoea". Cochrane Database Syst
Rev (3): CD002248. doi:10.1002/14651858.CD002248.pub3. PMID 17636702.
- ^ White A (2003). "A review of controlled
trials of acupuncture for women's reproductive health care". J
Fam Plann Reprod Health Care 29 (4): 233–6.
doi:10.1783/147118903101197863. PMID 14662058.
- ^ Jun E (2004). "[Effects of SP-6
acupressure on dysmenorrhea, skin temperature of CV2 acupoint and
temperature, in the college students]". Taehan Kanho Hakhoe
Chi 34 (7): 1343–50. PMID 15687775.
- ^ Witt CM, Reinhold T, Brinkhaus B, Roll S,
Jena S, Willich SN (2008). "Acupuncture in patients with
dysmenorrhea: a randomized study on clinical effectiveness and
cost-effectiveness in usual care". Am. J. Obstet. Gynecol.
198 (2): 166.e1–8. doi:10.1016/j.ajog.2007.07.041. PMID 18226614.
Chapman-Smith D (2000). "Scope of
practice". The Chiropractic Profession: Its Education,
Practice, Research and Future Directions. West Des Moines, IA:
Proctor ML, Hing W, Johnson TC,
Murphy PA (2006). "Spinal manipulation for primary and secondary
dysmenorrhoea". Cochrane Database Syst Rev (3): CD002119.
doi:10.1002/14651858.CD002119.pub3. PMID 16855988.
- ^ Tugay N, Akbayrak T, Demirtürk F, et
al. (2007). "Effectiveness of transcutaneous electrical nerve
stimulation and interferential current in primary dysmenorrhea".
Pain Med 8 (4): 295–300. doi:10.1111/j.1526-4637.2007.00308.x. PMID 17610451.
Schiøtz HA, Jettestad M, Al-Heeti D
(2007). "Treatment of dysmenorrhoea with a new TENS device (OVA)".
J Obstet Gynaecol 27 (7): 726–8. doi:10.1080/01443610701612805. PMID 17999304.
- ^ Proctor ML, Smith CA, Farquhar CM, Stones
RW (2002). "Transcutaneous electrical nerve stimulation and
acupuncture for primary dysmenorrhoea". Cochrane Database Syst
Rev (1): CD002123. doi:10.1002/14651858.CD002123. PMID 11869624.
- ^ Hedner N, Milsom I, Eliasson T, Mannheimer
C (1996). "[TENS is effective in painful menstruation]" (in
Swedish). Lakartidningen 93 (13):
1219–22. PMID 8656837.
- ^ Kaplan B, Rabinerson D, Pardo J, Krieser
RU, Neri A (1997). "Transcutaneous electrical nerve stimulation
(TENS) as a pain-relief device in obstetrics and gynecology".
Clin Exp Obstet Gynecol 24 (3): 123–6. PMID 9478293.
- ^ Kaplan B, Rabinerson D, Lurie S, Peled Y,
Royburt M, Neri A (1997). "Clinical evaluation of a new model of a
transcutaneous electrical nerve stimulation device for the
management of primary dysmenorrhea". Gynecol. Obstet.
Invest. 44 (4): 255–9. PMID 9415524.
Zhu X, Proctor M, Bensoussan A, Wu
E, Smith CA (2008). "Chinese herbal medicine for primary
dysmenorrhoea". Cochrane Database Syst Rev (2): CD005288.
doi:10.1002/14651858.CD005288.pub3. PMID 18425916.
- ^ Tanaka T (2003). "A novel
anti-dysmenorrhea therapy with cyclic administration of two
Japanese herbal medicines". Clin Exp Obstet Gynecol
30 (2-3): 95–8. PMID 12854851.
- ^ Morgan PJ, Kung R, Tarshis J (2002).
"Nitroglycerin as a uterine relaxant: a systematic review". J
Obstet Gynaecol Can 24 (5): 403–9. PMID 12196860.
- ^ Doubova SV, Morales HR, Hernández SF,
et al. (2007). "Effect of a Psidii guajavae folium extract
in the treatment of primary dysmenorrhea: a randomized clinical
trial". J Ethnopharmacol 110 (2): 305–10.
doi:10.1016/j.jep.2006.09.033. PMID 17112693.
- ^ Marsden JS, Strickland CD, Clements TL
(2004). "Guaifenesin as a treatment
for primary dysmenorrhea". J Am Board Fam Pract
17 (4): 240–6. doi:10.3122/jabfm.17.4.240. PMID 15243011. http://www.jabfm.org/cgi/pmidlookup?view=long&pmid=15243011.
- ^ Lemmens-Gruber R, Kamyar M (2008).
"[Pharmacology and clinical relevance of vasopressin antagonists]"
(in German). Internist (Berl) 49 (5):
628, 629–30, 632–4. doi:10.1007/s00108-008-2017-z. PMID 18335184.
- ^ "Mozon: Sykemelder seg på
grunn av menssmerter". 2004-10-25. http://www.mozon.no/php/art.php?id=349090. Retrieved
- ^ a
French L (2008). "Dysmenorrhea in
adolescents: diagnosis and treatment". Paediatr Drugs
10 (1): 1–7. PMID 18162003.
- ^ Sharma P, Malhotra C, Taneja DK, Saha R
(2008). "Problems related to menstruation amongst adolescent
girls". Indian J Pediatr 75 (2): 125–9.
doi:10.1007/s12098-008-0018-5. PMID 18334791.
- ^ Banikarim C, Chacko MR, Kelder SH (2000).
"Prevalence and impact of
dysmenorrhea on Hispanic female adolescents". Arch Pediatr
Adolesc Med 154 (12): 1226–9. PMID 11115307. http://archpedi.ama-assn.org/cgi/pmidlookup?view=long&pmid=11115307.
- ^ Sule ST, Umar HS, Madugu NH (2007).
"Premenstrual symptoms and dysmenorrhoea among Muslim women in
Zaria, Nigeria". Ann Afr Med 6 (2):
68–72. PMID 18240706.
- ^ Juang CM, Yen MS, Horng HC, Cheng CY, Yuan
CC, Chang CM (2006). "Natural progression of
menstrual pain in nulliparous women at reproductive age: an
observational study". J Chin Med Assoc
69 (10): 484–8. PMID 17098673. http://ajws.elsevier.com/ajws_pubmed/pubmed_switch.asp?journal_issn=1726-4901&art_pub_year=2006&%20art_pub_month=10&art_pub_vol=69&art_sp=484.
- ^ Vink CW, Labots-Vogelesang SM,
Lagro-Janssen AL (2006). "[Menstruation disorders more frequent in
women with a history of sexual abuse]" (in Dutch; Flemish). Ned
Tijdschr Geneeskd 150 (34): 1886–90. PMID 16970013.
- ^ Hilário SG, Bozzini N, Borsari R, Baracat
EC (2008). "Action of aromatase inhibitor for treatment of uterine
leiomyoma in perimenopausal patients". Fertil. Steril.
91: 240. doi:10.1016/j.fertnstert.2007.11.006. PMID 18249392.
- ^ Nabeshima H, Murakami T, Nishimoto M,
Sugawara N, Sato N (2008). "Successful total laparoscopic cystic
adenomyomectomy after unsuccessful open surgery using transtrocar
ultrasonographic guiding". J Minim Invasive Gynecol
15 (2): 227–30. doi:10.1016/j.jmig.2007.10.007. PMID 18312998.
- ^ Hacker, Neville F., J.
George Moore, and Joseph C. Gambone. Essentials of Obstetrics
and Gynecology, 4th ed. Elsevier Saunders, 2004. ISBN
- ^ Hubacher D, Reyes V, Lillo S, et
al. (2006). "Preventing copper intrauterine device removals
due to side effects among first-time users: randomized trial to
study the effect of prophylactic ibuprofen". Hum. Reprod.
21 (6): 1467–72. doi:10.1093/humrep/del029. PMID 16484309.
- ^ Johnson BA (2005). "Insertion and removal
of intrauterine devices". Am Fam Physician
71 (1): 95–102. PMID 15663031.
- ^ Cho S, Nam A, Kim H, et al.
(2008). "Clinical effects of the levonorgestrel-releasing
intrauterine device in patients with adenomyosis". Am. J.
Obstet. Gynecol. 198 (4): 373.e1–7. doi:10.1016/j.ajog.2007.10.798. PMID 18177833.
Dysmenorrhea at the Open
Diseases of the pelvis and genitals (N40-N99,
|reproductive system navs: anat