Dysmenorrhea is a medical condition characterized by painful cramps during menstruation. It is a common gynecological issue affecting women of all ages and races. It is also a major cause of pelvic pain. Scientists have figured out that the pain associated with dysmenorrhea emanates from the over-secretion of the prostaglandins and the increase in uterine contractility.
Epidemiology
Bernardi et al. (2017) asserted that the estimated prevalence of this condition is extremely and affects between 45% and 93% of women in their reproductive age. The highest rates of the condition are reported in adolescent girls. The rates of reporting are low because many women have been conditioned to accept it as a normal stage of development. As such, very few women seek medication. Statistics continue to show that between 3% and 33% of women experience severe pain (Bernardi et al., 2017). The pain is so severe that it can easily render them incapacitated for between 1 and 3 days of the menstrual cycle meaning that they can be absent from work and school. Osayande & Mehulic, (2014) asserts that the incidence of the disease is highest in women aged between 25 and 29 years. The risk, however, lowers as women attain the age of 44.
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Morbidity
Bernardi et al. (2017), in discussing the morbidity of the disease say, "Dysmenorrhea is the leading cause of gynecological morbidity in women of reproductive age regardless of age, nationality, and economic status.” The burden caused by this condition is more severe than any other known gynecological complain. The effects extend beyond the impact of the women to the society at large due to the reduced productivity. According to the World Health Organization (WHO), dysmenorrhea is the most significant cause of chronic pelvic pain in women (Bernardi et al., 2017). Other than the restrictions in daily life, the pain can be so overbearing that it results in reduced academic performance, poor quality of sleep, adverse impact on mood, and mental health conditions such as anxiety and depression.
Pathophysiology
During the menstrual cycle, the thickening of the endometrium happens in preparation for pregnancy. Since the ovum is not fertilized, pregnancy does not happen, and the built-up uterine wall sheds in the form of menses. During menstruation, prostaglandins are part of the molecular compounds that are released. The action of the prostaglandins and additional inflammatory mediators causes the contraction of the uterus (Bernardi et al., 2017). A combination of these factors has been identified as the primary cause of dysmenorrhea. The contraction of the uterine walls limits blood which is responsible for the pain that ensues.
Subjective and Objective Presentation
Dysmenorrhea is primarily characterized by abdominal or pelvic pain. The initial onset of the pain can occur between 6 and 12 months following menarche. The pain can last from eight to 72 hours and continues throughout the menstrual flow (Dawood, 2006). Other associated symptoms present during this period include headache, low back pain, fatigue, diarrhea, vomiting, and nausea.
Differential Diagnosis
The doctor will begin by taking the medical history of the menstrual pain which interferes with the daily activities. Currently, no standard gold technique has been established to measure or quantify the menstrual pains. A quantification model known as the menstrual symptometrics can be used to measure the extent of the menstrual pains and further correlate them with other parts of the human body (Bernardi et al., 2017). It can also estimate how the menstrual bleeding generally interferes with the daily activities of the patient. Other tests such as urine tests and pregnancy tests should be ordered to rule out the possibility of pregnancy or infection.
Treatment
The first line treatment for dysmenorrhea begins with the nonsteroidal anti-inflammatory drugs such as Celecoxib, Ibuprofen, Mefenamic acid, and Naproxen. Management of primary dysmenorrhea might require hormonal contraceptives with evidence showing that they can reduce the severity of the pain (Osayande & Mehulic, 2014). Complementary therapies might include yoga, acupuncture, and massage among other forms of exercise.
References
Bernardi, M., Lazzeri, L., Perelli, F., Reis, F. M., & Petraglia, F. (2017). Dysmenorrhea and related disorders. F1000Research, 6.
Dawood, M. Y. (2006). Primary dysmenorrhea: advances in pathogenesis and management. Obstetrics & Gynecology, 108(2), 428-441.
Osayande, A. S., & Mehulic, S. (2014). Diagnosis and initial management of dysmenorrhea. Am Fam Physician, 89(5), 341-346.
