Dysmenorrhea may be primary or secondary. Primary dysmenorrhea is caused by specific imbalances in the woman's endocrine system during the menstrual cycle. Secondary dysmenorrhea denotes menstrual cramps caused by some other distinct organic disorder. In most cases dysmenorrhea is primary.
Primary dysmenorrhea may occur a few days before the period, at the onset of bleeding, or during the total episode. The pain varies from a severe incapacitating distress to relatively minor and brief intense cramps.
Other symptoms may include irritability, fatigue, backache, headache, leg pains, nausea, vomiting, and cramping. Primary dysmenorrhea is caused by the endocrine system's release of excessive amounts of prostaglandins; these are hormonelike substances that stimulate the uterus to contract, thus causing the familiar cramps of the disorder. Drugs that block prostaglandin formation can decrease the severity of uterine contractions and can eliminate pain for many women with dysmenorrhea.
Secondary dysmenorrhea is much less common. It can be caused by genital obstructions, pelvic inflammation or degeneration, abnormal uterine wall separation or development (i.e., endometriosis), chronic infection of the uterus, polyps or tumours, or weakness of the muscles that support the uterus. Often the pain is dull, aching, and persistent. Tumours produce sharper pains. Treatment is directed toward the underlying disorder.
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Other Issues
Many women experience premenstrual discomfort. Tenderness of the breasts and a tendency to retain fluid (bloat) are common one to seven days before each period. Some women also experience a condition called premenstrual syndrome (PMS), which is characterized by headaches, irritability, nervousness, fatigue, crying spells, and depression with no apparent cause. A few women also experience menstrual cramps (dysmenorrhea) during the first day or two of the period. Although premenstrual symptoms and discomfort during menstruation were once thought to be of psychological origin, research now indicates that hormonal and chemical changes are responsible. New medications are effective in treating these problems.
