Causes of Menstrual Pain
The uterus is a muscle, and like all muscles, it contracts and relaxes. This happens throughout the menstrual cycle. During your period, the uterus contracts more strongly. These contractions are caused by prostaglandins — a substance made by the endometrium. Sometimes, when the uterus contracts it produces a cramping pain.

Types of Dysmenorrhea
There are two types of dysmenorrhea. Pain during your period can be classified as either primary or secondary dysmenorrhea.

Primary Dysmenorrhea
Primary dysmenorrhea is pelvic pain that is the result of having your period.

Primary dysmenorrhea often begins soon after a girl begins having menstrual periods. As a woman gets older, her periods often become less painful.

Secondary Dysmenorrhea
Secondary dysmenorrhea is menstrual pain that has another cause in addition to menstruation. With secondary dysmenorrhea, pain often begins earlier in the menstrual cycle. It usually lasts longer than normal cramps.

Some of the most common causes of secondary dysmenorrhea are:

• Endometriosis — a condition in which endometrial tissue is found in other areas in the body, such as the ovaries and fallopian tubes.

   

• Fibroids — tumors or growths that form on the outside, inside or in the wall of the uterus. They are not cancerous.

   

• Pelvic inflammatory disease — an infection of the uterus, fallopian tubes or ovaries.

   

• Intrauterine device (IUD) — a device placed in the uterus to prevent pregnancy.

Diagnosing Dysmenorrhea
Dysmenorrhea is diagnosed by exams and tests. Some of the tests may need to be done outside the doctor's office. For your doctor to diagnose a cause for dysmenorrhea, you will be asked to describe your history, symptoms and menstrual cycles.

In some cases, the doctor can learn more by looking directly inside your body. This is usually done by laparoscopy. This requires admission to an outpatient surgery unit, or even to the hospital.

Sometimes, the doctor is able to find a cause for the dysmenorrhea. But, often there is no known cause.

Medications
There are effective ways to treat menstrual pain. Your doctor can prescribe or suggest medications that can help relieve your discomfort.

NSAIDS
NSAIDs (nonsteroidal anti-inflammatory drugs) are drugs that block the production of the prostaglandins that cause menstrual cramps.

NSAIDs work best when they are taken at the first sign of your period or pain. You usually need to take them only for one or two days.

Taking oral contraceptives (birth control pills) also reduces menstrual pain. The birth control pill causes less growth of the endometrium.

Finally ...
Pain during the menstrual period is a common problem for women. Most of the pain is mild and can be treated with over-the-counter medications. Sometimes, however, menstrual pain is severe and requires medical treatment.

If you have severe menstrual cramps or cramps that last more than two or three days, call your doctor.

This excerpt from ACOG's Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.