Dysmenorrhea

What is dysmenorrhea?

Dysmenorrhea, or painful menstrual (period) cramps, is the most common symptom reported by teenagers during their periods. Having cramps and experiencing some pain during a menstrual period is normal. Dysmenorrhea is when the pain is not controlled by over-the-counter pain medication or impacts daily activities (e.g., your teenager misses school, does not see their friends).

There are two types of dysmenorrhea.

• Primary dysmenorrhea is the most common type and usually begins within one year of starting your period. Cramping pain in the lower abdomen typically begins 1-2 days before a period starts and lasts for a total of 2-4 days.
• Secondary dysmenorrhea is caused by a medical condition. Endometriosis is the most common cause of secondary dysmenorrhea. Other causes include infections, fibroids or growths.

What are menstrual cramps?

Menstrual cramps are caused by contractions (tightening and relaxing) of the muscles of the uterus, which allows blood to leave the uterus. Contractions are controlled by the hormone prostaglandin, released from the lining of the uterus. Prostaglandin levels are higher during the first few days of the menstrual cycle, so cramps are more painful during this time.

What are the symptoms of dysmenorrhea?

The main symptoms of dysmenorrhea are:

• cramping and pain in the lower abdomen
• pain in the lower back
• pain that spreads down the legs

Other symptoms of dysmenorrhea can include:

• nausea
• vomiting
• diarrhea
• headaches
• muscle cramps
• trouble sleeping

If your teenager has menstrual cramps that cannot be controlled by over-the-counter pain medication, pain that interferes with their daily activities or any of the above symptoms, they should make an appointment to speak with their health-care provider.

How is dysmenorrhea diagnosed?

Your teenager’s health-care provider will ask them about their symptoms, medical history and possibly family medical history. They will also have a physical exam, which may include a pelvic exam.

Their health-care provider may also recommend an ultrasound to check on the uterus and other internal reproductive organs if they suspect your teenager has secondary dysmenorrhea.

If relevant, some people may be tested for sexually transmitted infections (STIs).

How is dysmenorrhea treated?

Treatment will depend on symptoms, age and how severe the pain is. Your teenager’s health-care provider may recommend taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, starting 1-2 days before their period begins and continuing for the first few days of bleeding.

In some cases, their health-care provider may recommend hormonal birth control, such as combined oral contraceptive pills, intrauterine contraception, vaginal ring, contraceptive patch, contraceptive implant, or injectable contraception. Medications used for birth control are often used to treat dysmenorrhea even in people who are not having sex and do not need contraception.

Using a heating pad or hot water bottle can also help to improve blood flow and relieve pain. Exercise can help to reduce cramps.

For secondary dysmenorrhea, your teenager may be referred to a gynaecologist, a doctor who specializes in female reproductive health.