Menstrual Pain (cont.)

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• Menstrual cramps are sharp pains in a woman's lower abdomen that start when her menstrual period begins and may continue for 2-3 days or longer. Symptoms can range in severity from a mild annoyance to severe pain that interferes with normal activities.
• Menstrual cramps are the leading cause of absenteeism in women younger than 30 years of age. Although over half of women who have menstrual periods experience some discomfort, only a small percentage are disabled by the symptoms. The medical term for painful menstruation is dysmenorrhea.
• The following circumstances may make a woman more likely to experience menstrual cramps:
  • Onset of the first menstrual period at an early age (younger than 11 years)
  • Menstrual periods lasting 5 days or more
  • Cigarette smoking
  • A woman has never been pregnant (nulligravity)
  • Relatives with severe menstrual cramps

Menstrual cramps or primary dysmenorrhea occurs in the absence of any significant pathologic cause for the pain. This type of menstrual pain is most commonly seen in young women during the years following the onset of menstruation.

Secondary dysmenorrhea refers to painful menstrual cramps that occur as a result of a true pathological condition (for example, endometriosis). This condition is more commonly seen in older women (30-45 years of age).

Prostaglandins and menstrual pain: Prostaglandins are chemicals that a woman's body produces that cause many of the symptoms associated with menstrual discomfort. The tissue that lines the uterus (endometrium) produces these chemicals, and they are released with the onset of menses when the uterine lining breaks down. Prostaglandins stimulate the uterine muscle to contract. Women who have high levels of prostaglandins experience more intense contractions of their uterus, and these produce more pain. Prostaglandins also may be responsible for vomiting, diarrhea, and headaches that frequently accompany painful periods.

Other menstrual-type pain or secondary dysmenorrhea can be caused by conditions of the reproductive tract, such as the following:

• Endometriosis: uterine tissue that appears outside the uterus
• Fibroids: non-cancerous (benign) tumors that involve the uterus
• Adenomyosis: migration of endometrial glands downward into the muscular wall of the uterus
• Infections: infections involving the reproductive organs
• Ectopic pregnancy: a pregnancy that occurs outside of the uterus such as in the Fallopian tubes
• IUD (intra-uterine device) used for birth control
• Ovarian cysts
• Narrow cervix: cramps due to passing clots of blood and tissue through and anatomically narrow cervical canal
• Stress

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