Dysmenorrhea - Causes, Symptoms, Diagnosis & Treatment

Dysmenorrhea: A Common Problem in Women

Dr.Meenakshi  Sahu profile Authored by Dr.Meenakshi Sahu on 11 Apr 2014 - 14:16.

Dysmenorrhea (menstrual cramps) is a condition of painful menstruation, which often includes severe cramps in the lower abdomen and back. When the uterus contracts to expel the flow, it utilizes the prostaglandin (a chemical responsible for pain and inflammation). This procedure increases the level of prostaglandin in your body which is believed to be responsible for the painful cramps.

For most of the women, cramping may begin even before starting of the periods.  Severity of pain may vary and may interrupt your daily activities. Dysmenorrhea is usually caused by some underlying medical conditions but in the absence of a medical condition, it may go away after child delivery.

Types of Dysmenorrhea

Based on the root cause of the painful menstruation, dysmenorrhea is divided into two types:

          1. Primary dysmenorrhea: Painful menstruation in the absence of any underlying disease


  • Mostly begins within your first 6 periods
  • Pain often persists for2-3 days
  • Pain may start a few hours before or just after the flow started
  • Constant cramps in the lower abdomen, lower back and thighs
  • Often it goes undiagnosed on pelvic examination

    2. Secondary dysmenorrhea: Painful menstruation caused due to underlying pelvic diseases.


  • Mostly begins once you enter into20s or 30s
  • Irregular and heavy menstrual flow
  • Significant vaginal discharge
  • Do not respond to treatment with non-steroidal anti-inflammatory (NSAIDs) or oral contraceptives infertility drugs
  • Dyspareunia


Dysmenorrhea can be caused by several underlying health conditions, especially pelvic diseases, including:

Endometriosis: It is a painful clinical condition caused when the tissues lining the uterus grow abnormally out of uterus, especially on ovaries, fallopian tubes, and the pelvis lining.

Adenomyosis: It is a condition caused when the uterus lining tissues are also present inside your uterus and abnormally grows to invade the muscular walls.

Uterine fibroids: It is a condition caused due to uncontrolled growth of the cells (noncancerous) of the uterus.

Cervical stenosis: It is a condition of painful menstruation caused due to the small opening of the cervix, which restricts menstrual flow and thus, increases pressure inside the uterus.

Pelvic Inflammatory Disease (PID):It is a condition of painful inflammation of the pelvis caused due to sexually transmitted bacterial infection.


Some common symptoms of dysmenorrhea include:

  • Mild to severe cramps in the lower abdomen, which often radiates to lower back
  • Cramps in the leg and thighs

Many women (but not all) may experience the following symptoms:

  • Dizziness
  • Nausea
  • Vomiting
  • Excessive sweating


Diagnosis of Dysmenorrhea involves multiple tests and examinations such as, assessment of medical history, physical examination and other laboratory tests.

Assessment of medical history: As an initial approach towards the diagnosis, your doctor may ask:

·        Your age of menarche (when you started getting your periods)

·        Details about your menstrual cycle like frequency, duration occurrence of inter-menstrual bleeding and other symptoms during the periods

·        Details about the type and duration of pain and effect of dysmenorrhea on your day to day life

·        History of having child


Physical examination: Mainly it includes a pelvic examination to inspect the external genitals, vaginal vault, uterine irregularities, tenderness and cervix in addition to biannual examination.


Diagnostic and imaging tests:

Based on your history assessment and pelvic examination, if any underlying condition is observed, then the doctor may perform the following tests to confirm the diagnosis:

o   SonographyTo look out for irregularities in the internal organs including fallopian tube, uterus and cervix.

o   Magnetic resonance imaging (MRI): It produces clear and detailed images of desired internal organ and thus, tumors or endometriosis can be easily spotted.

o   Computerized tomography (CT): It produces images of the desired organ from various angles and provides very detailed and clear images, making it possible to rule out any visible sign and symptom.

o   Hysteroscopy: To look for the presence of fibroids or polyps in the womb, with the assistance of the telescope kind of equipment inserted into the womb.

o   Laparoscopy: To check for abnormal signs and symptoms of conditions like cyst, abnormal mass of cells, fibroids and ectopic pregnancy.  This procedure involves inserting a tiny tube equipped with a small camera.

Lab examinations:

Your doctor may perform certain laboratory tests if required. These mainly include:

o   Blood test: Blood count, Erythrocyte Sedimentation Rate (ESR)

o   Tests to rule out infections: Enzyme immunoassay, DNA probing test, and  tests for Gonococcal and chlamydial

o   Test for the chronic gonadotropin level

o   Urine and stool assessment

o   Carcinogenicity test


Some factors may increase your risk of having, these factors include:

  • Age under 20yr
  •  Smoking
  • Early menarche (first period) on or before the age of 11
  • Heavy flow
  • Irregular periods
  • Close family history 


It does not contribute to any complicated health issues right away, but usually disturbs day to day life. Moreover, underlying causative pelvic diseases may cause some complications, for example:

o   Endometriosis – Can make woman unable to conceive

o   Pelvic inflammatory disease - Scarring of the fallopian tubes may lead to abnormal  pregnancy in the fallopian tube (ectopic pregnancy)

Dysmenorrhea can be treated well using various options like:


  • Non-steroidal anti-inflammatory drugs (NSAIDs) - To relieve the pain and cramps
  • Hormonal pills/ implants/injection/vaginal ring- To reduce the severity of pain by avoiding ovulation.

Surgical approach: To remove the abnormal tissue, causing underlying condition and reduces the symptoms.

Lifestyle interventions and home cures:

Alternative therapeutic approaches to menstrual cramps include:

  • Exercising daily
  • Acupuncture therapy by experts
  • Transcutaneous electrical nerve stimulation (TENS) to release body's natural painkiller (endorphins).
  • Consuming food containing vitamin E, omega-3 fatty acids; vitamin B1 and B6 and magnesium.
  • Using a heating pad


Dysmenorrhea can be prevented by practicing a healthy lifestyle that includes physical activity and appropriate healthy diet.

*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.