Dysmenorrhea: Painful Cramps During Menstruation.

Dysmenorrhea is one of the most common menstrual-related problems in women. Dysmenorrhea is a term used to describe painful cramps during menstruation. Menstruation will occur every month (without fertilization) lasting 3-5 days and following the menstrual cycle, which averages 28 days. In some women menstruation sometimes causes daily activities hampered because of the extremely painful periods.


It is a disruption during menstruation which is characterized by extreme pain so that you cannot carry out activities. Symptoms that may occur are the presence of pain such as being attracted to the inner thighs, nausea to vomiting, headaches, and dizziness. 

Dysmenorrhea is caused because the uterus has contracted. The reaction from the muscles will affect prostaglandin. Prostaglandin will experience an increase when the start of menstruation then decreases after the onset of menstruation, resulting in pain that diminishes after the first day of menstruation.


Primary dysmenorrhea.

There are 2 types of dysmenorrhea: primary and secondary dysmenorrhea. Primary dysmenorrhea is another name for normal menstrual cramps. Cramps usually occur in one or two days before a woman gets menstruation.

Pain is usually felt in the lower abdomen or back, can be mild pain to severe pain. Menstrual cramps often start shortly before or at the beginning of the period and continue for one to three days. Pain will decrease with the age of a woman and can stop completely after a woman has her first baby.

Primary dysmenorrhea is not caused by problems in the reproductive organs. This condition is generally caused by an increase in prostaglandin, which is produced in the lining of the uterus. Increased prostaglandin triggers contractions of the uterus. Naturally, the uterus tends to have stronger contractions during menstruation which can cause menstrual pain.

Secondary dysmenorrhea.

Secondary dysmenorrhea caused by conditions or disorders of the female reproductive system. Pain due to secondary dysmenorrhea usually occurs earlier than usual menstrual pain and lasts longer. Various conditions that can cause complaints of secondary dysmenorrhea are:
  1. Endometriosis
  2. Pelvic Inflammatory Disease (PID) / pelvic inflammatory disease
  3. Cyst or tumor in the ovary
  4. Stenosis or blockage of the cervix
  5. Adenomyosis
  6. Fibroids
  7. Uterine polyps
  8. Adhesions to the inside of the uterus
  9. Congenital malformations (bicornuate uterus, uterine subseptate, etc.)
  10. Use of an intrauterine device (IUD)
  11. Transverse septal vaginal discharge
  12. Pelvic congestion syndrome
  13. Allen-Masters syndrome

Dysmenorrhea causes.

The causes of menstrual pain can vary. Menstrual pain or dysmenorrhea is a common thing in most women. Pain can feel mild or unobtrusive. However, severe menstrual pain that is felt during menstruation or persistent pain and getting heavier after menstruation can indicate the existence of certain diseases or conditions.

Menstrual pain is generally felt by some women at the beginning of the menstrual period. In some women, pain in the lower abdomen is not so pronounced that they can still move as usual. However, others felt the pain that was unbearable until they could not do anything.

During the menstrual period, the walls of the uterus produce a hormone called prostaglandin. This hormone causes the uterus to contract and often causes pain. Women with more than normal amounts of prostaglandins can experience cramps. Pain occurs when part of the muscle loses oxygen supply for some time.

Over time, when the hormone conditions have stabilized, this menstrual cramps will stop. However, for secondary dysmenorrhea, there are other causes such as:
  1. A condition occurs where there are cells that look and act like cells lining the uterus (endometrium) and are found in other parts of the abdominal cavity (endometriosis) or grow into additional muscle tissue in the uterine wall (adenomyosis). Pain usually occurs 1-2 days before menstruation begins and continues throughout the menstrual period.
  2. Structural body anatomy that occurs at birth (congenital), such as narrowing of the lower part of the uterus that opens into the vagina (cervix).
  3. Pelvic infection. The risk of a woman having an infection is higher during menstruation because the opening of the cervical pathway (cervix) widens during menstruation. But pelvic infections, especially those caused by sexually transmitted infections, can occur at any time other than when the menstrual period.
  4. Using intrauterine contraception (IUD). An IUD can cause increased cramps during the menstrual period for the first few months of use. If menstrual cramps continue or worsen, you may need to look for other birth control methods.
  5. Endometriosis: occurs when cells that cover the uterus begin to grow outside the uterus, such as the ovary or fallopian tube. These cells can cause severe pain when decaying.
  6. Fibroids: non-cancerous tumors in the uterus and can make your painful menstruation.
  7. Cervical stenosis: the opening of the cervix of some women is much small, thus inhibiting blood flow to get out during menstruation. This condition causes painful pressure in the uterus.
Secondary dysmenorrhea is generally accompanied by other symptoms such as irregular menstruation, thick and smelly vaginal discharge, bleeding between menstrual periods, and pain during sexual intercourse. Even for some women feeling menstrual pain is riskier because of experiencing the following things:
  1. More menstrual volume
  2. Having first menstruation before the age of 11 years.
  3. Obese or overweight.
  4. Never been pregnant.
  5. Eating alcoholic beverages or smoking.
Menstrual pain cannot be considered trivial. You should immediately consult a doctor if excessive bleeding occurs, the menstrual period is longer than usual, accompanied by a fever, there is abnormal vaginal discharge, pain arises suddenly and feels intense on the pelvis, and the presence of signs of infection such as fever or chills and body pain during menstruation.

Dysmenorrhea symptoms.

Symptoms of dysmenorrhea that arise depend on the type of dysmenorrhea itself. In primary dysmenorrhea, symptoms that appear generally are as follows:
  1. Pain appears adjacent to the first menstruation/menarche (generally in the first 6 months).
  2. 48-72 hours long (often appears a few hours before menstruation or once you start menstruation).
  3. Pain such as cramps or labor pain.
  4. Pain in the lower abdomen can spread to the back or thighs.
  5. Can be accompanied by complaints of nausea, fatigue, bloating.
  6. Often complaints decrease with age, or after giving birth.
While the symptoms of secondary dysmenorrhea are usually:
  1. Generally, complaints appear at the age of 20 or 30, where the previous menstrual cycle is not accompanied by complaints of pain.
  2. Menstrual pain progressively increases and lasts longer than normal menstrual pain.
  3. Menstruation is more than normal or irregular cycles.
  4. The presence of infertility.
  5. Presence of dyspareunia (pain during intercourse)
  6. Abnormal discharge of vaginal discharge.

Dysmenorrhea treatment.

In primary dysmenorrhea, pain complaints often improve with anti-pain medication. In addition, hormonal therapy can also be given.

Lifestyle changes can also help deal with complaints. Routine exercise, ensuring adequate sleep, avoiding smoking and consuming alcohol. Relaxation techniques, warm compresses in the abdominal area that are painful and back and stomach massage can also help.

Treatment of secondary dysmenorrhea is adjusted for the disease that causes this complaint. Therefore, it is important that the causes of secondary dysmenorrhea be evaluated.

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