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Dealing with Dysmenorrhea
Can Painful Periods Impact Your Fertility?
By Teri Brown
There are two main types of dysmenorrhea:
- Primary, no organic cause
- Secondary, pathologic cause
According to Dr. Flood-Shaffer, primary dysmenorrhea is associated with ovulatory menstrual cycles. When a woman ovulates, she has an increase in prostaglandins. The pain has been attributed to prostaglandin activity and its effect on the uterine muscle. There can be some psychological factors involved as well, including attitudes passed from mother to daughter or sister to sister, etc.
"Because dysmenorrhea is nearly always associated with ovulatory cycles, it does not usually occur at menarche (first menses), but rather later in adolescence," Dr. Flood-Shaffer says. "Up to 25 percent of adolescents miss work or school as a result of this pain."
Pain typically occurs on the first day of the menses usually about the time flow begins. Nausea, vomiting, diarrhea and headache may also occur. The specific symptoms of endometriosis are not present. A physical exam doesn't reveal any significant pelvic disease. In other words, there's nothing wrong; the menses are just particularly painful.
According to Dr. Flood-Shaffer, treatment for primary dysmenorrhea is ibuprofen or acetaminophen. Mefamenic acid and COX-2 inhibitors are also quite useful in relieving pain, but their cost can be a limiting factor. Local heat (heating pad) and rest can give temporary relief as well. Occasionally stronger analgesics are required. "Oral contraceptive agents are highly effective due to the absence of ovulation and an altered endometrium – there is less prostaglandin production and therefore less pain," Dr. Flood-Shaffer says.
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