Dysmenorrhea, Causes, Diagnosis, Treatment, Prevention, Complications
Dysmenorrhea or menstrual pain is pain or cramps in the lower abdomen that appear before or during menstruation. Dysmenorrhea can be mild, but it can also be so severe that it interferes with daily activities.
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| Dysmenorrhea, Causes, Diagnosis, Treatment, Prevention, Complications |
Dysmenorrhea is divided into two types, namely primary and secondary. Primary dysmenorrhea is cramps that appear before or during menstruation, then disappear when the menstrual period ends.
While secondary dysmenorrhea is dysmenorrhea due to disorders of the reproductive organs. Patients with secondary dysmenorrhea will feel cramps longer than primary dysmenorrhea.
The cramps in secondary dysmenorrhea get worse as menstruation progresses. In some cases, cramps are still felt even after menstruation has ended.
Symptoms and Complications of Dysmenorrhea
The main symptom of dysmenorrhea is cramps in the lower abdomen. These symptoms are normal and nothing to worry about. With age, dysmenorrhea will gradually disappear.
Although it rarely causes complications, symptoms of dysmenorrhea can interfere with daily activities. Especially in dysmenorrhea caused by certain diseases, complications can arise in the form of:
- Fertility problems
- Fallopian tube infection
- Pregnant outside the womb
Treatment and Prevention of Dysmenorrhea
Dysmenorrhea can be treated independently by applying warm compresses to the stomach, taking warm baths, or taking pain relievers. However, if dysmenorrhea is severe, treatment needs to be done by a doctor.
Cramps during menstruation are normal. However, worsening cramps during menstruation can be prevented by taking the following steps:
- Exercise regularly, at least 30 minutes every day
- Get enough rest and sleep
- Eat a complete and balanced nutritious diet
- Limit consumption of caffeine, especially near menstruation time
- Do not smoke and consume alcoholic beverages
- Manage stress, among others by doing relaxation techniques
Causes of Dysmenorrhea
Primary dysmenorrhea is caused by the activity of the hormone prostaglandin which normally functions to make the muscles and blood vessels of the uterus contract.
The levels of the prostaglandin hormone will be very high on the first day of menstruation, then decrease as the menstrual period progresses. Therefore, the pain is most intense on the first day of menstruation, then disappears when menstruation is over.
There are a number of factors that make women experience cramps during menstruation, namely:
- Under 30 years old
- Have a mother or sister who also experiences menstrual pain
- Experiencing menstruation is not smooth
- Have experienced puberty before the age of 11 years
- Experiencing excessive bleeding during menstruation
- Smoke
While secondary dysmenorrhea can be caused by diseases of the reproductive organs, such as:
- Endometriosis, which is a condition when the tissue that forms the inner lining of the uterine wall grows outside the uterus, for example in the fallopian tubes (fallopian tubes) or ovaries (ovaries).
- Adenomyosis, which is a condition when the tissue that forms the inner lining of the uterine wall grows into the uterine wall muscles.
- Myoma, which is a benign tumor on the wall of the uterus.
- Pelvic inflammation, due to infection of the female reproductive organs that has spread to the pelvic cavity.
- Narrowing of the cervix, which prevents menstrual blood from flowing out of the uterus.
The main symptom of dysmenorrhea is pain or cramps in the abdomen which can also be felt in the lower back and thighs. The characteristics of cramps that are felt can be different for each person. In some cases, cramps will be very painful.
Cramps can appear before or when menstruation starts, generally for 1–3 days. In secondary dysmenorrhea, cramps will continue even though menstruation is over.
Apart from cramps, dysmenorrhea can also cause the following symptoms:
- Nauseous
- Vomit
- Dizzy
- Headache
- Pain during intercourse
When to See a Doctor
Immediately consult a doctor if you feel severe dysmenorrhea in each menstrual period. Also consult a doctor if the cramps are felt to interfere with daily activities.
You are also advised to seek medical help immediately if:
- Menstrual pain occurs after the installation of spiral birth control
- Menstrual pain occurs for three consecutive menstrual periods
- Pain accompanied by diarrhea and nausea
- Low back pain appears even when you are not menstruating
- Menstrual blood that comes out in the form of clots
- Symptoms of severe dysmenorrhea are only felt at the age of 25 years and over
Cramps or pain in the pelvis that appears suddenly can be a sign of an infection. If not treated immediately, infection in the pelvic area can cause infertility.
Immediately see a doctor if you experience signs or symptoms of infection, such as:
- Excessive pain in the pelvic area
- Pain that appears suddenly
- vaginal discharge
- Fever
Diagnostics of Dysmenorrhea
The doctor will conduct questions and answers about the menstrual cycle and the symptoms that are felt. Next, the doctor will perform a physical examination of the vagina, uterus and pelvis.
Physical examination of the vagina is carried out using a speculum. The goal is to find out the signs of abnormalities in the reproductive organs.
If an abnormality is suspected, the doctor will suggest the following supporting examinations:
- Scanning
The doctor will do a pelvic ultrasound examination to see the condition of the uterus, cervix, fallopian tubes, and ovaries. If needed, the doctor can do a CT scan or MRI of the pelvis, to get a clearer picture.
- Hysteroscopy
Hysteroscopy is performed by inserting a special tool in the form of a small camera tube through the vagina. The goal is to see the condition in the uterus.
- Laparoscopy
The doctor will make a small incision in the abdomen and then insert a small tube with a camera to see the condition of the reproductive organs. Laparoscopy can help doctors find out whether menstrual pain is caused by endometriosis or myoma.
Dysmenorrhea Treatment
Cramps due to dysmenorrhea can be treated alone at home without the help of a doctor. Efforts that can be made include:
- Massaging and warm compresses on the sore stomach area
- Light exercise, such as walking, yoga, or cycling
- Do relaxation, for example with yoga or pilates
- Take a warm shower
- Take supplements that contain vitamin E, vitamin B6, omega 3, and magnesium
If the cramps do not subside, the patient can take over-the-counter pain relievers, such as ibuprofen or paracetamol. In patients who smoke, the doctor will advise them to stop smoking immediately.
If the cramps are very painful, consult a doctor immediately. The doctor will find out the cause and determine the appropriate treatment method. Some ways doctors can do to relieve cramps are:
Administration of drugs
Doctors can prescribe non-steroidal anti-inflammatory drugs (NSAIDs) or hyoscine butylbromide, to relieve cramps. In addition, doctors can prescribe birth control pills to reduce the thickness of the inner lining of the uterine wall so that the uterine muscles don't have to contract excessively.
Operation
Surgery is performed if the cramps are caused by endometriosis or myoma. Surgical removal of the uterus (hysterectomy) may be an option if other treatment methods have not worked or if the patient is no longer planning to become pregnant.
TENS (transcutaneous electrical nerve stimulation)
Doctors can recommend patients to undergo TENS therapy. TENS is performed by passing a mild electric current to the nerves in the pelvic area, to block pain signals.
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