What is Dysmenorrhea?
Dysmenorrhea refers to pain with menstruation and is classified into two categories — primary and secondary. Primary is caused by prostaglandins, a chemical that lines the uterus and causes contractions. When this occurs, nausea and vomiting may be common during a woman’s period. The cramps may start a day or two before menstruation and may persist after the menstruation period has stopped (x).
While cramping will normally subside about 24 hours after the peak of the period, it may persist secondary to an underlying condition associated with secondary amenorrhea. This outcome may also be the case when there is stomach cramping with no period, an indication that there may be an irregularity such as ectopic pregnancy or uterus incapacity (x).
Secondary dysmenorrhea refers to dysmenorrhea caused by a disorder of the female reproductive organs with pain starting earlier in the menstrual period. Nausea and vomiting are not usually associated with this condition (x).
Symptoms of Dysmenorrhea
The symptoms of dysmenorrhea will differ depending on whether a woman is facing primary or secondary dysmenorrhea. Regardless of the type, it can be anticipated that cramps and pain will be present, whether it is before, during, or after the menstrual period (x).
First and foremost, cramping is most commonly associated with back pain. While many women do not fully understand why this back pain occurs, it can be attributed to the prostaglandins mentioned previously when describing the mechanism of primary dysmenorrhea (x).
As the prostaglandins cause contraction at the uterus, the contractions and associated pain can radiate to the lower back. As with all parts of the body, the lower back is connected to the rest of the chain that is situated below it. When contractions occur, the entire area will begin to tighten and cause a sort of spasm at the lower back. Most often this cramping will start anywhere between 1-3 days before the onset of one’s period (x).
As the lower back starts to be affected by contractions, the legs may additionally tighten up, especially on the back-side, due to their interconnectedness with the low back. The tightening of the back muscles normally shortens the muscles of the hamstrings, which causes more pain with movement than would normally be experienced and an additional stress when performing activity and moving (x).
In the case of secondary dysmenorrhea, one’s period may be delayed if an underlying condition is present. Despite this delay, it is still expected that cramping will be present as the body works to respond to and correct the dysfunction occurring at the reproductive organs (x).
Vomiting during one’s period is common in the case of primary dysmenorrhea. While there are a number of factors that may contribute to this side effect, including hormones and the inability to tolerate severe cramp associated pain, prostaglandins are normally the cause. Commonly, diarrhea and headaches may occur in combination with nausea and vomiting during pregnancy (x).
In addition to the normal cramping and back pain associated with menstruation, period exhaustion may be present as a part of pre-menstruation. This fatigue affects many women with dysmenorrhea and is often caused by a number of symptoms including but not limited to stress, low iron levels, depression, difficulty sleeping and inadequate physical activity (x).
While period exhaustion is not uncommon, living a regularly active and healthy lifestyle can combat its symptoms. This focus must include a well-balanced diet and consistent physical activity (x).
Menstrual Cramps During Pregnancy
It has become a common misconception that women cannot experience menstrual-like cramps while they are pregnant. Once menstrual periods cease and pregnancy is either suspected or confirmed, the expectation is that women will only be faced with kicking later in their pregnancy or contractions at the time of labor (x).
The truth is that even during the first and second trimester, menstrual-like cramps can occur. This happens due to the stretching out of the uterus, causing a stress on the muscles and ligaments associated with it. While it can be easy to become concerned once these cramps begin, as long as they are not too severe in intensity or associated with other symptoms such as bleeding, there is generally no need to worry about cramping early on in pregnancy (x).
However, if the pain associated with cramps becomes extreme or is linked with other symptoms, immediate medical attention should be obtained. Often these symptoms may indicate a problem with the pregnancy. This condition may be fatal to both the mother and the unborn baby (x).
In the less extreme cases, cramps will feel similar to how they are during normal menstrual periods. While it may be unexpected, symptoms should not be much different and thus should not normally cause a major concern. Symptoms of cramping that do not align with normal menstrual cramps in severity or other associated symptoms should be noted immediately (x).
Complications of Dysmenorrhea
While there are relatively few complications that result from primary dysmenorrhea, secondary dysmenorrhea has been known to be associated with lasting issues that can cause damage to the female body and produce lasting effects (x).
One of the most common complications associated is the expelling of the uterine lining as part of a condition referred to as endometriosis. In a normal functioning reproductive system, the uterine lining will be expelled from the body through blood flow consistent with a regular menstrual period. However, in this case the uterine lining often gets trapped, causing severe cramping and pain (x).
Uterine scarring is another complication that may result due to trauma to the inner layer of the uterus. Typically, scar tissue or other deposits will form, causing trauma as extreme cramping when this inner layer is unable to be shed as normal through menstrual flow (x).
One complication of dysmenorrhea is menorrhagia, also known as excessive bleeding or prolonged bleeding during the menstrual period. This can be especially dangerous due to the amount of blood lost and should be monitored carefully, especially in physically active females (x).
In the case of tubal ligation, or the “typing” of the fallopian tubes, severe menstrual cramps have been detected. Many women report an increase in the amount of pain present with cramps after tubal ligation as well as a change in the pattern of when these cramps occur; these issues shift from their original cycle.
Fever and Chills
In some extreme cases of secondary dysmenorrhea, fever and chills have been associated. These symptoms commonly manifest in response to another condition within the body and cause a systemic response to trigger complications within the female reproductive system (x).
Living with Dysmenorrhea
While living with dysmenorrhea may provide many women with the worst cramps of their lives, there are ways to adjust lifestyles to effectively deal with cramps at school, at work and throughout the day. First and foremost, it is recommended to avoid food and drinks that cause bloating and water retention such as those high in salt, caffeine, fatty acid, and any form of alcohol in general (x).
Severe uterine train can be aided by the use of ibuprofen, a drug that specifically targets prostaglandins that are being produced in excess in response to potential damage of the reproductive organs. While it is not fully understood why severe uterine pain occurs, making some periods worse than others, studies report how these symptoms are specific to each woman and may be reflective of general inflammation or an underlying condition (x).
Treatment for Dysmenorrhea
Treating dysmenorrhea will vary depending on whether you are dealing with primary or secondary dysmenorrhea. Also, the individual response to certain pharmacological agents is a major determining factor for which treatment methods may or may not be effective for females suffering from severe cramps (x).
Primary dysmenorrhea management will usually rely on pharmacological measures such as acetaminophen, naproxen, or naproxen alternatives in the form of other NSAIDs. Acetaminophen will aid only by pain relief, while any NSAID derivative may help with a reduction in inflammation and irritation within the uterus (x).
In extreme cases, prescription medicine for menstrual cramps may be advised by your physician if over the counter medications are ineffective. Prevention of cramps has been shown to occur for women who regularly consume magnesium by relaxing the uterine muscles (x).
When treating period nausea, it is recommended to consume bland foods that will not further upset the stomach. Additionally, using anti-nausea medications may prove to be useful as well as home remedies such as ginger-based products (x).
Supplements for Menstrual Cramps
Despite the traditional options for limiting the effects of menstrual cramps, whether through diet or the use of a heating pad, more options are available through the use of dietary supplements. These supplements target specific physiological mechanisms of cramping, especially those that deal with the inflammatory response to prostaglandins or reproductive organ dysfunction.
One of those potential supplements is Methylsulfonylmethane, or MSM, a supplement commonly used for a number of inflammatory conditions ranging from arthritis to menstrual cramps. The supplement is focused on limiting inflammation caused by prostaglandins by decreasing another chemical stimulator of inflammation – cytokines (x).
While the research on MSM is mainly focused on joint health, it has been shown to reduce inflammatory expression in vitro with the promise of translating these results to the majority of inflammatory conditions that affect the body (x).
Another popular supplement for combatting menstrual cramps is dehydroepiandrosterone or DHEA powder. While this is naturally produced in the human body and coverts easy to hormones, such as testosterone or estrogen, it can be used to assist in fertility and proper sexual function (x).
In supplement form, it can be converted to estrogen that will promote proper menstrual flow and prevent back-ups that will lead to severe cramping. While it does not specifically target mechanisms of inflammation, it does promote regular functioning and overall menstrual health (x).
Ginger Root Extract
Ginger root extract has been shown to be one of the most effective treatments through prevention of primary dysmenorrhea. While it has a number of anti-inflammatory properties, it most notably inhibits prostaglandin production and thus limits the effects of contractions/cramps during the menstrual period (x).
Devil’s Claw Extract
The last supplement that is commonly used to treat menstrual cramps comes in the form of Pure Devil’s Claw Extract, or Harpagophytum, a plant-based product that combats pain and inflammation. While similar to MSM in that it is often used for joint pain, it has shown the ability to combat inflammatory responses throughout the body, thus limiting pain through prostaglandin modulation (x).
The Bottom Line
Dysmenorrhea can be pesky, but there are various treatments to the condition. Supplements like ginger root extract, DHEA and MSM can help one find relief. And if supplements don’t work, simply try avoiding foods and drinks that cause bloating and water retention.