It is the pain associated with menstruation and the most commonly reported menstrual disorder affecting a lot of women.

Dysmenorrhea is thought to be caused by the release of chemicals in the menstrual fluid which eventually causes powerful contractions of the uterus and subsequently pain The chemicals are prostaglandins and vasopressin. The blood vessels supplying the uterus with oxygen rich blood contract and leading to ischaemia ( reduced oxygen supply to then cells) leading to pain.

Elevated vasopressin levels have been reported in women with primary dysmenorrhea.

There are two types of dysmenorrhea:

Primary dysmenorrhea  and Secondary dysmenorrhea.

Primary dysmenorrhea

What causes primary dysmenorrhea?

It is painful menses in women with normal pelvic anatomy and do not have any disease affecting the female reproductive system especially the process of menstruation. It begins usually during adolescence and is characterized by cramps I the pelvic or lower abdominal region shortly before or at the onset of menses. The pain or cramps lasts one to three days.

Primary dysmenorrhea usually is caused by natural chemicals called prostaglandins which are made in the lining of the uterus and the pain usually decreases as the levels of prostaglandins decrease and as menstruation continues and the lining of the uterus is shed.

Pain usually occurs right before menstruation starts and primary dysmenorrhea begins soon after a girl starts having menstrual periods. In many women with primary dysmenorrhea, menstruation becomes less painful as they get older or begins childbirth.

Primary dysmenorrhea may improve after giving birth.

Secondary dysmenorrhea

Secondary dysmenorrhea is caused by a disorder in the female reproductive system. The pain often lasts longer than normal menstrual cramps and may begin a few days before a menstrual period starts. The pain worsens as the menstrual period continues and may persist even after the menstruation has ended.

Secondary dysmenorrhea begins later in life than primary dysmenorrhea.

Causes secondary dysmenorrhea

Endometriosis— It is a disorder where tissues from the lining of the uterus arer found outside the uterus, such as in the ovaries and fallopian tubes, behind the uterus, on the bladder etc. Endometriosis tissue which are the same as the lining of the uterus breaks down and bleeds in response to cyclical changes in hormones. This bleeding can cause pain, especially right around menstruation. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs causing the organs to stick together, resulting in pain.

Adenomyosis—Tissue that normally lines the uterus begins to grow in the muscle wall of the uterus. It is the presence of endometrium within the myometrium. Spontaneous miscarriage has been observed more frequently in women with adenomyosis. Women with adenomyosis present with menorrhagia ( excessive bleeding during menstruation), dysmenorrhea and  occasionally, dyspareunia ( pain during sexual intercourse)

 Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus). Fibroids located in the wall of the uterus can cause pain.

To be continued…

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