Dysmenorrhea is painful menstruation (periods or menses).

Painful periods (dysmenorrhea) is a common complaint among young females, but the majority of cases are not due to disease, and the physical exam is normal. Dysmenorrhea has been reported to be significantly increased among mothers and sisters of women with the condition.

Primary dysmenorrhea is painful periods without an underlying cause. It usually occurs in adolescents usually begins 2 to 3 years after a female starts menstruating. Pain may be mild to severe, and may be associated with stomach problems. Primary dysmenorrhea occurs when a naturally-occurring substance in the body called prostaglandin cause the uterus to contract.

Secondary dysmenorrhea means painful periods due to an underlying illness, such as endometriosis and pelvic inflammatory disease. Secondary dysmenorrhea most commonly begins in women in their 20s. An increase in sexually transmitted diseases among adolescents has lead to a greater number of cases of secondary dysmenorrhea.

• Lower abdominal crampy pain -- occurs before the beginning of the menstrual period and lasts 1 or 2 days into the period
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Back pain

The health care provider will perform a physical exam and ask questions about the patient's medical history to determine whether or not the painful periods are due to a medical condition.

Younger females who have not become sexually active may require a pelvic examination (performed through the rectum rather than through the vagina).

The goal of treatment is to relief pain. Medicines may include:

• Anti-inflammatory medications such as aspirin
• Nonsteroidal anti-inflammatory medications (NSAIDS) such as ibuprofen (available over-the-counter or in prescription strengths)
• Prescription-only medications such as indomethacin

In some severe cases and disorders such as endometriosis, oral contraceptives can be helpful. They are used to regulate the hormone levels in the body (they may be prescribed even for girls who are not sexually active).

Women who continue to have severe dysmenorrhea despite the use of NSAIDS or oral contraceptives may require a surgical procedure called laparoscopy to investigate the problem of the pain.

Mild pain killers usually work to relief painful periods. Oral contraceptives generally control severe cases. Dysmenorrhea associated with a disease gets better when the underlying problem is treated. 

There are no complications from primary dysmenorrhea. Complications may develop from secondary dysmenorrhea, depending on the disease or condition present.

If you (or your daughter) experience painful menstrual periods and the pain disrupts your life, occurs frequently, or is not relieved by over-the-counter medications, see your primary health care provider or gynecologist.

There are no specific preventive measures for dysmenorrhea. Avoiding sexually transmitted diseases will decrease disease-associated dysmenorrhea.

Stenchever A. Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001:1065-1070.

Noble J. Textbook of Primary Care Medicine. 3rd ed. St. Louis, Mo: Mosby; 2001:325.