As leading gynecologists in the greater New York city area, Maiden Lane Medical offers women the most advanced treatments for dysmenorrhea so they can find relief from symptoms of pain and irregular bleeding and reduce their chances for pregnancy complications.
What is dysmenorrhea?
Painful menstruation is termed dysmenorrhea. It is a common issue for women in their reproductive years and can range from mild pelvic cramping to severe pain interfering with daily activities such as school or work. The pain is usually sharp intermittent cramping in the midline of the pelvis starting around the start of a period typically lasting 1-3 days. There may also be associated symptoms of nausea, vomiting, diarrhea, headache, and backache.
What causes dysmenorrhea?
Primary dysmenorrhea occurs during menstruation when the inner lining of the uterus, or endometrium is shed and releases hormones called prostaglandins. These prostaglandins induce painful uterine contractions.
Secondary dysmenorrhea occurs when painful menstrual cramps are due to another physical issue outside of menstruation such as the following:
- Endometriosis: implants of uterine lining cells outside of the uterus in the pelvis & abdomen
- Fibroids: benign muscular tumors of the uterus
- Adenomyosis: gland growth within the walls of the uterus
- Ovarian cysts: Variety of different solid or fluid-filled masses on the ovary
- Pelvic inflammatory disease (PID): Sexually transmitted infection that has
- spread to the uterus, ovaries, fallopian tubes, inner pelvis and abdomen
- Uterine malformations: structural abnormalities from birth such as a
- narrowing or blockage where the cervix opens into the vagina
How is dysmenorrhea diagnosed?
The evaluation for dysmenorrhea is centered on ruling out the causes of secondary dysmenorrhea. Primary dysmenorrhea does not involve any changes on exam, labs or imaging.
- History: Diagnosis starts with a careful history of location, type, duration, timing and severity of the pain as well as associated symptoms.
- Physical exam: Secondary dysmenorrhea may include abnormal tenderness at the cervix or ovaries in cases of infection. Other causes may
- causes area of thickening, enlargement or irregularly shaped structures at the ovaries or uterus.
- Laboratory work: Blood work may reflect signs of infection in cases of PID.
- Imaging: Transvaginal pelvic sonogram or pelvic MRI is used to evaluate the anatomy of the abdomen and pelvis with a focus on the ovaries and uterus.
How is dysmenorrhea treated?
Primary dysmenorrhea is treated with over-the-counter nonsteroidal anti-inflammatory medications such as Advil or Motrin. A heating pad is often used to help ease pain symptoms. Contraception such as oral contraceptives, NuvaRing or an intrauterine device may also resolve heavy bleeding and cramping pain.
Secondary dysmenorrhea treatment depends on the exact cause. Oral or intravenous antibiotic treatment is used in cases of PID. Medical and surgical options exist for endometriosis, fibroids, ovarian cysts and adenomyosis. Medical treatment is aimed at symptom control. Surgical options such as laparoscopy or robotic assisted laparoscopy can be minimally invasive methods utilized to obtain a diagnosis as well as treat the primary condition.