Menstrual Pain – Dysmenorrhea

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Dysmenorrhea is a term used to describe painful menstrual periods during which a woman has lower abdominal cramps, pain (sharp or aching) that comes and goes, and lower back pain. Excessive pain such as this is not a normal part of menstruation.

Dysmenorrhea is divided into two groups: primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea occurs around the time that a woman gets her first menstrual period. It is believed to be related to hormonal changes in the woman’s body. Secondary dysmenorrhea is pain that develops later in life in women who have previously had normal periods. It is frequently associated with problems in the uterus or ovaries, including endometriosis (a condition in which cells that line the uterus grow out into other areas of the body), fibroid tumors (painful, benign uterine tumors), pelvic inflammatory disease, premenstrual syndrome, sexually transmitted infections, stress and anxiety.

There are many behavioral modifications that can be utilized to minimize the pain of dysmenorrhea. A brief list is as follows:

  • Use of a heating pad on the lower abdomen or back
  • Drinking warm beverages
  • Eating light but frequent meals
  • Avoiding salt, sugar, alcohol, and caffeine in the diet
  • Elevating the legs while reclined
  • Meditation or yoga
  • Over-the-counter anti-inflammatory medications such as Advil or Aleve, taken the day before a period is due to start and then throughout the first few days after it begins
  • Vitamin and mineral supplements such as B6, calcium, and magnesium
  • Warm baths and showers
  • Regular exercise and maintenance of a healthy body weight

If these behavioral measures do not provide relief, physicians may prescribe antibiotics, antidepressants, birth control pills, or prescription-strength anti-inflammatory medications or pain relievers.

Natural products that have demonstrated possible effectiveness in treating the pain associated with dysmenorrhea include anise, celery, saffron (Nahid et al., 2009), fish oil (Harel et al., 1996; Deutch et al., 2000; Goldberg & Katz, 2007), and vitamin E (Ziaei et al., 2001; Pathak et al., 2003).

Research on Dysmenorrhea and Fibromyalgia

Due to the increased pain sensitivity that often accompanies fibromyalgia, women with fibromyalgia are more likely to report having dysmenorrhea. For about 15% of women the pain can be so severe that it interferes with activities of daily living. Despite the frequent association between dysmenorrhea and fibromyalgia, the research investigating the prevalence and relationship between the two is lacking.

A 1989 study by Yunus et al. evaluated 113 patients with fibromyalgia, 77 with rheumatoid arthritis, and 67 healthy control subjects who reported no significant aches and pains. The purpose of the study was to determine the clinical features for fibromyalgia and to see if there was any relationship between fibromyalgia and irritable bowel syndrome, chronic headache, and primary dysmenorrhea. The researchers found that all three conditions were significantly more common in the fibromyalgia patients.

A 2004 study of factors associated with fibromyalgia in patients with systemic lupus erythematous (commonly called lupus, a long-term immune disorder that affects the joints, skin, hair, kidneys, and brain) found that dysmenorrhea was much more common among patients with fibromyalgia than among those with generalized pain disorders. This study was limited in that it was conducted exclusively in Mexican lupus patients and included only 18 patients with fibromyalgia (Valencia-Flores et al., 2004).

In 2006, Shaver et al. conducted a telephone survey of 442 women with fibromyalgia and 205 women without fibromyalgia in order to compare overall health status, reproductive and sleep-related issues, and lifestyle behaviors between the two groups. With regard to women’s health issues, the study found that women with fibromyalgia were more likely to report having had reproductive health problems, including dysmenorrhea. Based on their findings, the researchers concluded that patients with fibromyalgia need careful assessment for various reproductive conditions and state that more research is needed to investigate the causes of such symptoms (Shaver et al., 2006).

Learn more about Fibromyalgia HERE.

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References

1.        Ziaei S, Faghihzadeh S, Sohrabvand F, et al. A randomised placebo-controlled trial to determine the effect of vitamin E in treatment of primary dysmenorrhoea. BJOG. 2001;108:1181-1183.

2.        Pathak A, Roth P, Piscitelli J, Johnson L. Effects of vitamin E supplementation during erythropoietin treatment of the anaemia of prematurity. Arch Dis Child Fetal Neonatal Ed. 2003;88:F324-328.

3.        Nahid K, Fariborz M, Ataolah G, Solokian S. The effect of an Iranian herbal drug on primary dysmenorrhea: a clinical controlled trial. J Midwifery Womens Health. 2009;54:401-404.

4.        Harel Z, Biro FM, Kottenhahn RK, Rosenthal SL. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. 1996;174:1335-1338.

5.        Deutch B, Jorgensen EB, Hansen JC. Menstrual discomfort in Danish women reduced by dietary supplements of omega-3 PUFA and B12 (fish oil or seal oil capsules). Nutr Res. 2000;20:621-631

6.        Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007;129:210-223.

7.        Yunus MB, Masi AT, Aldag JC. A controlled study of primary fibromyalgia syndrome: clinical features and association with other functional syndromes. J Rheumatol Suppl. 1989;19:62-71.

9.     Shaver JL, Wilbur J, Robinson FP, Wang E, Buntin MS. Women’s health issues with fibromyalgia syndrome. J Womens Health (Larchmt). 2006;15(9):1035-45.

10.  Valencia-Flores M, Cardiel MH, Santiago V, Resendiz M, Castano VA, Negrete O, Rosenberg C, Garcia-Ramos G, Alcocer J, Alarcon-Segovia D. Prevalence and factors associated with fibromyalgia in Mexican patients with systemic lupus erythematosus. Lupus. 13(1):4-10.

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