Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 7, 2016

Dysmenorrhea or menstrual cramps affect more than half of all menstruating women. Symptoms include headaches, fatigue, and nausea. At least one in four women who experience these problems needs medication to functionally normally. Even though dysmenorrhea, which is also referred to as menstrual pain, is not a life-threatening condition, its symptoms can cause much distress.


Definition & Facts

This medical condition occurs in about 80 percent of women within three years of first having a period (menarche). It is the most common cause of lost time from school and work. Dysmenorrhea begins right before or just after the onset of menstrual flow, and the pain may spread to the inner thighs and lower back. This condition is more common in women who haven't had a child.

There are two main types of menstrual pain: primary and secondary dysmenorrhea. The first one doesn't have a pathological cause. Secondary dysmenorrhea develops years after the first period and may be triggered by certain diseases or abnormalities of the female reproductive system.

Symptoms & Complaints

Dysmenorrhea is characterized by pain during menstruation. Some women also report digestive problems, extreme fatigue, migraines, vomiting, and hypersensitivity to light. They usually experience a dull, throbbing pain that starts in the lower abdomen. The intensity of symptoms varies from one woman to another. Other symptoms of dysmenorrhea may include:

Certain conditions associated with dysmenorrhea, such as pelvic inflammatory disease and endometriosis, can affect fertility and cause damage to the reproductive organs. It's recommended to get medical help immediately if experiencing fainting, severe diarrhea, or fever over 102 degrees Fahrenheit or 38.9 degrees Celsius.


Menstrual pain is caused by contractions in the uterus. It typically becomes less painful as a woman ages. Most symptoms are triggered by the changes in hormonal levels occurring with ovulation. Pain can range from mild to severe, and decreases as menstruation continues. Contrary to popular belief, dysmenorrhea is not the same as PMS (premenstrual symptom).

Primary dysmenorrhea is caused by prostaglandins. These naturally occurring chemicals are made in the lining of the uterus. The level of prostaglandins increases before menstruation starts, causing the uterus to contract; excessive levels can lead to pain and cramps in the lower abdomen.

Secondary dysmenorrhea is usually caused by endometriosis, pelvic congestion syndrome, ovarian cysts, leiomyoma, or sexually transmitted infections. Some women develop dysmenorrhea because of cervical stenosis, adenomyosis, or pelvic inflammatory disease. Certain types of birth control can increase the severity of symptoms. In some cases, the pain is caused by uterine fibroids or scoliosis.

Dysmenorrhea is more likely to occur in women under 30 as well as in those who have never given birth. Other risk factors include cigarette smoking, genetic factors, irregular menstrual bleeding, and early puberty. Mental disorders are another possible risk factor. Anxiety, depression, and chronic stress have been associated with menstrual pain.

Diagnosis & Tests

Dysmenorrhea is considered primary in the absence of an underlying condition. It typically occurs six to 12 months after menarche. Urine testing may be needed to rule out infection or pregnancy. The diagnosis is based on physical examination and clinical history of the patient. Patients may require a pelvic examination.

In order to diagnose secondary dysmenorrhea, the doctor may recommend a saline microscopy of vaginal fluid, pelvic or vaginal ultrasonography, pelvic MRIs, and laparoscopy with biopsy and histology. Abnormalities in the timing of the menstrual cycle and the severity of pain may indicate endometriosis. This condition can be diagnosed through rectovaginal examination. The physician will also request information about the past obstetric history, previous known or suspected pelvic disorders, and past or present IUD use.

Treatment & Therapy

Treatment options for dysmenorrhea depend on the cause and severity of symptoms. These may include extended-cycle oral contraceptives, hormonal contraceptives, nonsteroidal anti-inflammatory drugs, vitamin E supplements, and COX-2 inhibitors. In rare cases, hysterectomy may be needed.

Some women are prescribed drugs that suppress the menstrual cycle, such as leuprorelin and danazol. These therapies have been shown to be effective but have serious side effects. Treatment can also include medications that help relax the uterus, such as diclofenac and oral nifedipine.

Research indicates that topical heat therapy, thiamine supplements, fish oil, acupuncture, and low fat vegetarian diet may ease menstrual pain. Regular exercise is recommended too. Many women experience pain relief after using toki-shakuyaku-san (TSS) and other herbal remedies.

Prevention & Prophylaxis

Although dysmenorrhea cannot be prevented, there are ways to manage its symptoms. Taking nonsteroidal anti-inflammatory drugs for up three days before the onset of menses can help relieve menstrual cramps. Women suffering from this condition should avoid stress and get more rest before and during their period.

Relaxation techniques, such as meditation and yoga, can reduce the intensity of symptoms. Smoking cessation and good nutrition may prevent pain. A small number of studies suggest that acupuncture and behavioral treatments can help in managing this condition.

Women can reduce the severity of dysmenorrhea by following a healthy diet, working out regularly, and practicing safe sex to avoid sexually transmitted diseases. Swimming, jogging, treadmill walking, and other forms of exercise may increase serotonin levels in the brain which helps reduce the perception of pain.

Certain foods, such as almonds, green vegetables, celery, hummus, and bananas, can relieve menstrual cramps and relax the muscles. Dairy products, sugary treats, and alcohol can actually trigger cramps, so they should be avoided. Women dealing with menstrual pain should consume whole, natural foods and cut back on caffeine during their period.