DYSMENORRHEA

Dysmenorrhea is uterine cramping that occurs in association with a period. It is felt to be caused by a high level of prostaglandin production (a substance produced by the uterus) in some women.

In other women, the presence of fibroids, adenomyosis, or endometriosis may be the cause. Dysmenorrhea is very common. Many women have mild-to-moderate cramps associated with their periods; severe dysmenorrhea occurs in approximately 15% of women.

Dysmenorrhea can be treated with medication (see below). Sometimes it spontaneously disappears or becomes much less bothersome after the delivery of a baby. In some cases, it lessens with age.

Although most women with dysmenorrhea have cramps, some women have sharp, stabbing pains and others have a sensation of dull pressure. Women may have the discomfort or pain in the lower abdomen, the lower back, or in both the front and the back.

Dysmenorrhea can be accompanied by nausea, vomiting, diarrhea, and on some occasions, sweating, shaking, and headache. The severity of the symptoms can vary from month to month; sometimes the cramping may be mild, other times severe.

Over-the-counter ibuprofen can be very effective in relieving the cramps. Over-the-counter ibuprofen comes in 200-milligram tablets. You can start with 2 tablets every 4 hours. However, if this does not relieve the cramps enough, you can take 3 tablets (600 milligrams) every 6 hours or 4 tablets (800 milligrams) every 8 hours. You should always take ibuprofen with some food on your stomach to avoid stomach irritation. (Obviously, you should not take ibuprofen if you have an allergy to it, have been told you should not take it or aspirin-like products, or have a history of ulcer or gastritis.)

Prescription medication may be prescribed for you if over-the-counter ibuprofen does not seem to be effective.

If ibuprofen and ibuprofen-like medications do not treat your dysmenorrhea effectively, birth control pills may be prescribed if appropriate. Birth control pills can be very effective in decreasing dysmenorrhea with the additional benefit of making the periods lighter.

If you take ibuprofen or ibuprofen-like medications for your dysmenorrhea, watch for stomach irritation. Taking too much ibuprofen, taking it on an empty stomach, or having a sensitivity to it may cause a stomach ulcer.

• If medication has been recommended, it is very important to take the medication before the dysmenorrhea becomes severe.
• Your doctor may recommend that you start the medication even before the cramps begin.
• Take ibuprofen and ibuprofen-like medications with some food in your stomach to avoid stomach irritation and decrease the risk of ulcer.
• Exercise may help decrease dysmenorrhea.
• Heat, such as a heating pad, hot water bottle, or soaking in a hot tub may relieve some symptoms.

• Don't take ibuprofen or ibuprofen-like medications on an empty stomach.
• Don't take more medication than recommended or prescribed.

• If the medication is not relieving the dysmenorrhea satisfactorily.
• You are not tolerating the medication.
• Your dysmenorrhea is becoming progressively worse despite current treatment.

Understanding Your Body: Every Woman's Guide to Gynecology and Health. Felicia Stewart, M.D., Felicia Guest, M.D., Gary Stewart, M.D., and Robert Hatcher, M.D., Bantam Books, 1987.




Sitting-up exercises for dysmenorrhea. A, Supine position with head and legs raised simultaneously; arms should be kept at side and legs straight. B, Deep knee bends; back should be kept straight. C, Monkey walk; keep hands flat on floor and walk about on hands and feet. D, Toe touching; keeping back straight and the legs straight, bend and touch toes with hands. (From Hood GH, Dincher JR: Total Patient Care: Foundations and Practice of Adult Health Nursing, ed 8. St Louis, Mosby—Year Book, 1992. Used by permission.)

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