Acute menstrual pain or dysmenorrhea is a common health problem among women that can be disabling and affect quality of life. Dysmenorrhea is severe throbbing or cramping pain in the lower abdomen or pelvic area. Other symptoms include low back pain, nausea, diarrhea and headaches. Dysmenorrhea can be primary, when there is no structural gynecological disorder that can explain the pain, or secondary, associated with a pelvic abnormality.
Primary dysmenorrhea is the most common type and is believed to be due to an excess of prostaglandins, which are responsible for uterine contractions and ischemia. The pain usually appears with menstruation or one to three days before it, is usually more intense 24 hours after the start of menstruation and, although it usually disappears gradually at the end of the first day, it can persist throughout menstruation. This type of dysmenorrhea is more common in young women between 17 and 25 years old, just after menarche, and its symptoms usually improve with age and after pregnancy.
Secondary dysmenorrhea can be caused by any abnormality that affects the pelvic viscera, such as endometriosis, which is the most common, but also uterine adenomyosis, fibroids, congenital malformations, ovarian cysts or adhesions. The pain is more continuous and heavier, usually appears a week before menstruation, and may ease, worsen or persist during menstruation. In general, secondary dysmenorrhea is more frequent in women over 30 years of age, unless it is caused by congenital malformations.
Treatment may include drugs, pain relief techniques, and in some cases may require surgery. Pharmacological treatments include non-steroidal anti-inflammatory drugs (NSAIDs), which reduce pain, blood loss and uterine contractility, and combined oral contraceptives, which, by inhibiting ovulation, reduce associated pain, thin the endometrium and they decrease the production of prostaglandins and menstrual bleeding.
Pain-relieving techniques include physical exercise, adequate rest with regular sleep, topical heat with a hot bath or heating pad on the lower abdomen, smoking cessation, a low-fat, plant-based diet fats, and nutritional supplementation, such as omega-3 fatty acids, flaxseed, magnesium, vitamin B1, vitamin E, and zinc.
