dysmenorrhea medically refers to severe pain that occurs before and during menstruation. They occur when the uterus contracts under the effect of prostaglandins, specific molecules. The uterus, the organ that allows the fetus to develop, undergoes contractions throughout the menstrual cycle. However, during menstrual periods, the uterus contracts more to eliminate the endometrium in the form of blood: this is menstruation. In women with dysmenorrhea, there is excessive contraction of the uterus. It therefore exerts strong pressure on the blood vessels, which disrupts the oxygen supply to the muscle tissues. The pain then manifests when a muscle is temporarily deprived of oxygen. We distinguish two forms of dysmenorrhea: primary and secondary.
What is primary dysmenorrhea?
Primary dysmenorrhea is when the pain starts from the beginning of the girl's first period and lasts throughout her life. Primary dysmenorrhea causes severe and recurrent menstrual pain due to excessive uterine contractions.
What is secondary dysmenorrhea?
Secondary dysmenorrhea is defined as that which appears after the onset of menstruation, and not from the very beginning. It has a hidden cause behind it.
The causes of painful menstruation? Endometriosis, Adenomyosis, and Fibroids
Primary dysmenorrhea seems to be linked to an excessive secretion of prostaglandins. The menstrual cramps of secondary dysmenorrhea are the result of problems affecting the reproductive organs, including:
- Endometriosis: in women affected by endometriosis, the tissue that lines the uterus (the endometrium) spreads outside the uterus. Since these areas of tissue are sensitive to hormones, during menstruation, they can cause swelling and pain.
- Adenomyosis: in the case of adenomyosis, the uterine lining develops in the muscle of the uterus. During menstruation, this causes abnormal bleeding and intense pain.
- Fibroids: these benign growths develop inside, outside, or in the walls of the uterus.
- Endometrial polyps.
- An intrauterine contraception (IUD or intrauterine device) that is no longer in its place.
- An unsuitable hormonal contraception.
What are the symptoms of dysmenorrhea?
The symptoms of dysmenorrhea can be perceived differently by each young girl or woman. We generally encounter the following signs:
- cramps and pelvic pain;
- a lower back pain, that is, pain in the lower back; pain that radiates down the legs;
- nausea, even vomiting;
- diarrhea;
- generalized fatigue;
- muscle weakness;
- malaise (fainting);
- headaches.
The signs of dysmenorrhea resemble those of diseases that can be serious. It is therefore recommended to see a doctor or a gynecologist to get a diagnosis. Furthermore, dysmenorrhea can, over a long period, lead to psychological distress due to the disability and pain it causes.
How is dysmenorrhea diagnosed?
To diagnose dysmenorrhea, the practitioner reviews the patient's medical and family history while asking her questions about her symptoms. He then proceeds with a gynecological examination. During the pelvic exam, the practitioner inspects for the presence of gynecological disorders and signs of infection. He generally orders or performs other tests to clarify his diagnosis and identify the origin(s) of the dysmenorrhea, including:
- A pelvic ultrasound: thanks to sound waves, the doctor can visualize the uterus, cervix, fallopian tubes, and ovaries.
- A pregnancy test: this helps to rule out pregnancy as the cause of the pain.
- A hysterosalpingography or echohysterography: this imaging test allows for the visualization of endometrial polyps, uterine mucosal fibroids, or congenital anomalies.
- An MRI (magnetic resonance imaging): it is recommended in cases of congenital anomalies, in order to better visualize them and consider treatment by surgery