Dysmenorrhoea is monthly painful cramps at the time of menstruation; it can be primary or secondary.
Primary dysmenorrhoea is painful periods not associated with another identifiable pelvic condition or disease. Primary dysmenorrhoea peaks between the ages of 20 and 24 years of age and then decreases. Between 15 to 30% of young women suffer from severe primary dysmenorrhoea. Primary dysmenorrhoea generally starts within a year of first period (menarche) which correlates to when ovulatory cycles first occur. Risk factors include early age starting periods (eg. Less than 12), low body mass index and family history.
The pain associated with primary dysmenorrhoea tends to be crampy and spasmodic and tends to start a few hours after the onset of menstrual flow and peaking 24 to 36 hours into the period. Other symptoms can include backache, nausea, vomiting and diarrhoea.
Secondary dysmenorrhoea is a consequence of another condition or disease affecting the pelvic area. It typically affects women from their thirties upwards and is associated with other symptoms such as dyspareunia (painful sexual intercourse) and disturbances of the menstrual cycle. The commonest cause of secondary dysmenorrhoea is endometriosis. Endometriosis is when the lining of the uterus grows in other places including the ovaries, fallopian tubes, and stomach.
Other causes of secondary dysmenorrhoea
Pelvic infection that can lead to adhesions surrounding the ovaries that can obstruct/ block the fallopian tubes leading to hydrosalpinges and thus dysmenorrhoea. Fibroids and polyps are other causes of dysmenorrhoea. They are non-cancerous growths in the uterus that sometimes need an operation to remove.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are effective at relieving menstrual pain in dysmenorrhoea (apart from aspirin). Studies show 45–53% of women taking NSAIDs for dysmenorrhea had moderate or excellent pain relief. There is little evidence of superiority of one NSAID over another. The three-day regimen of NSAIDs used for dysmenorrhoea rarely causes side effects.
Contraceptives suppress ovulation which improves symptoms of dysmenorrhoea. Inhibition of ovulation and reduced volume of endometrium during menstruation reduces the volume of prostaglandins produced, thus relieving menstrual cramps and menstrual pain. The combined oral contraceptive can also be taken continuously to reduce the number of cycles the patient goes through.
Another option for dysmenorrhea in women who do not require contraception is the synthetic progestogen called Dydrogesterone (Duphaston®) at a dose of 10mg twice a day from day 5 to day 26 of menstrual cycle.