Dysmenorrhea refers to the symptom of painful menstruation. There are two types of dysmenorrhea: primary and secondary.
Primary dysmenorrhea, the more common of the two, is due to the production of prostaglandins. These are natural substances made by cells primarily in the inner lining of the uterus. When the lining starts to shed during menstruation, these prostaglandins are released. They cause the uterus to contract forcefully, which is the main cause of menstrual cramps. They also cause vasodilation of the circulatory system: the arteries and veins expand so that blood is pooled instead of being circulated. This can cause pelvic congestion (blood pooling in the pelvis) which in turn causes discomfort and heaviness. It can also cause a drop in blood pressure, leading to a patient feeling cold, clammy, or lightheaded as the blood is diverted.
Secondary dysmenorrhea is most commonly caused by endometriosis, which can be visually confirmed via laparoscopy in approximately 70% of adolescents with dysmenorrhea. Other causes may include leiomyoma, adenomyosis, and ovarian cysts.
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, specifically in the umbilical region or the suprapubic region. The pain is commonly felt in the right or left abdomen. It may also radiate to the thighs and lower back. Along with menstrual pain, symptoms may also include nausea; vomiting; diarrhea; constipation; headaches; dizziness; disorientation; hypersensitivity to sound, light, smell, and touch; fainting; and fatigue. Symptoms often begin immediately following ovulation and can last until the end of menstruation.
Most women with menstrual cramps take aspirin or another common pain reliever, such as Tylenol or Aleve. However, these medicines may cause upset stomach, nausea, and diarrhea and can increase the risk of heart attack and stroke. These drugs work to relieve pain by suppressing the production of prostaglandins, which are important mediators of uterine activity in maintenance of blood flow. Thus, pain relievers may actually interrupt blood flow through the excessive suppression of prostaglandin production. This can cause pelvic congestion and exacerbate, rather than relieve, certain symptoms such as discomfort and heaviness.
From the perspective of Oriental medicine, excessive menstrual pain is considered a condition of “stagnation”. Stagnation refers to a lack of blood flowing through an organ. In the case of menstrual cramps, stagnation is thought to occur in the lower abdomen, irritating the body when the shedding of tissue occurs. To address the excess contraction and constriction that causes painful periods, the key is to help regulate blood flow in the lower abdomen, normalize smooth contractions, and reduce cramps. Certain acupuncture points are thought to regulate blood flow through the abdominal cavity and relax the nervous system, which can help calm muscular contractions. Studies show that acupuncture is just as effective as, if not more effective than, over-the-counter anti-inflammatory medicines for reducing pain. It should be noted however that excessively painful menstruation can be a sign of a more serious underlying issue, such as endometriosis, uterine infection, or a problem with the uterine anatomy.
For effective treatments in your daily life, doctors recommend using heat as a way to relieve pain associated with menstrual cramping. There are a couple different types of home treatment you can try:
1) Use a heating pad or hot water and apply it to the stomach or lower abdomen
2) Keep your body warm by avoiding short skirts/shorts or light clothes in the winter
3) Avoid coffee and alcohol
4) Exercise regularly. Studies show that women who exercise regularly often have less menstrual pain.
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