Back To CoursePathophysiology Textbook
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Dr. Gillaspy has taught health science at University of Phoenix and Ashford University and has a degree from Palmer College of Chiropractic.
Women are given the exclusive blessing of being able to become pregnant and carry a child. This blessing comes with what some woman consider a curse - I'm talking about the monthly menstrual cycle. Each month the lining of a woman's uterus builds up as it prepares for the arrival of a fertilized egg. If no fertilization, and therefore no pregnancy, occurs then the uterus sheds the built-up tissues.
For some of the women of reproductive age this monthly process goes on without a hitch, but for others the process brings painful menstrual cramps, a condition referred to as dysmenorrhea. Dysmenorrhea sounds like one of those complicated medical terms, but you can recall it fairly easily if you break it down. For instance, the prefix 'dys' means difficult, and the latter part of the word, 'menorrhea,' sounds the same as menstrual cycle, so dysmenorrhea is simply a difficult menstrual cycle. You might be wondering what causes this condition and why is it so bad in some women? Well, these are questions we will explore in this lesson.
Pain that comes around at the same time as a woman's monthly cycle or period is not uncommon, but it can vary in intensity from one woman to the next. Some women may experience mild symptoms that amount to nothing more than some discomfort or a feeling of heaviness in the lower abdomen. Others may experience moderate to severe symptoms that last up to a few days and interfere with the woman's ability to perform normal daily activities, like going to school or work. These symptoms include sharp lower abdominal pains that come and go in waves, as well as lower back pain, headaches, nausea and possibly constipation or diarrhea.
So, what causes all this pain and discomfort and why do some women have to endure it every month? Well, remember when we talked about the uterus shedding built-up tissue each month if there's no fertilized egg? When this tissue breaks down it releases prostaglandins, which are hormone-like substances that promote uterine contractions. They occur naturally in a woman's body, but prostaglandins can also be given as a medication to a woman in labor to increase uterine contractions and help the birthing process along.
So in pregnant women, prostaglandins help deliver the baby. Whereas in a woman who is not pregnant, they encourage the contractions that help expel the old uterine lining out of the uterus and through the cervix, which is the doorway out of the uterus. In fact, it's thought that women who have a narrow cervical canal or elevated prostaglandin levels may be prone to more severe menstrual pain due to the added pressure and intensity.
As all of this is going on leukotrienes, which are substances that encourage an inflammatory response, are also produced. It might help you recall this term if you remember that the prefix 'leuko' refers to white or white blood cells, which are the cells that are called on when there's an inflammation to fight and the suffix 'trienes' sounds like 'trying,' as if the leukotrienes are trying to call the white blood cells by causing an inflammation. So, we can summarize the causes of dysmenorrhea as the uterine contractions spurred on by the prostaglandins, coupled with the inflammation spurred on by the leukotrienes.
There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea is described as painful menstrual cramps that begin within the first year of menstruation that are unrelated to an underlying condition. The term 'primary' is often used to describe something that happens early, much like we might think of elementary school as primary school, so you can use this fact to help recall the early onset of this type. With the primary type there's no underlying problem with the reproductive system, but there may be contributing factors, such as stress, poor diet and a lack of exercise that worsens the symptoms.
Secondary dysmenorrhea is described as painful menstrual cramps related to an underlying condition. If something is secondary, it typically comes after, which is what we see with the onset of secondary dysmenorrhea, as it tends to develop later, after a woman has experienced normal cycles.
The key difference is that with secondary dysmenorrhea, there's an underlying condition that is exacerbating the pain and discomfort. This could include a number of reproductive disorders, but commonly involves endometriosis, which is a condition in which tissues of the uterine lining develop outside the uterus. It's as if the normal tissues from the lining of the uterus, known as the endometrium, get lost and start to develop elsewhere in the pelvis.
Another condition that can contribute to secondary dysmenorrhea is uterine fibroids, which are benign tumors that grow within the uterus. Being benign means they are not cancerous, and a woman might not even be aware of their presence until they contribute to symptoms, such as severe pain, during the woman's periods.
Treatment of dysmenorrhea may depend on the type. For example, if severe symptoms are caused by an underlying problem, as could be the case with secondary dysmenorrhea, then that condition may need to be corrected first via surgery or other medical means. Yet, as a general rule the pain and cramping of dysmenorrhea can often be controlled through healthy lifestyle practices that include adequate sleep, regular exercise and a healthy diet.
Heat, applied over the lower abdomen using a heating pad or from a warm bath, may relieve mild pain and cramping. There are a number of over-the-counter medications designed for menstrual symptom relief and nonsteroidal anti-inflammatory drugs (NSAIDS), like ibuprofen and naproxen, can be effective because they lower the production of prostaglandins.
Another treatment option is the use of birth control pills or oral contraceptives. This medication's intended use is to prevent ovulation, which is the release of an egg from the ovaries so pregnancy can be avoided, but it also reduces the production of prostaglandins, which helps lessen the painful cramping.
Let's review. Dysmenorrhea is the term used to describe painful menstrual cramps. Symptoms range from mild symptoms that may create discomfort or a feeling of heaviness in the lower abdomen to moderate to severe symptoms that include sharp lower abdominal pains, lower back pain, headaches, nausea and possibly constipation or diarrhea.
Prostaglandins are hormone-like substances that promote uterine contractions, and leukotrienes are substances that encourage an inflammatory response. These substances are released during the monthly breakdown of the uterine lining and it's the uterine contractions spurred on by the prostaglandins, coupled with the inflammation spurred on by the leukotrienes that are identified as the causes of dysmenorrhea. Women who have elevated prostaglandin levels or a narrow cervical canal may be prone to more severe menstrual pain.
There are two types of dysmenorrhea. Primary dysmenorrhea is described as painful menstrual cramps that begin within the first year of menstruation that are unrelated to any underlying condition. Secondary dysmenorrhea is described as painful menstrual cramps related to an underlying condition that typically starts later in a woman's reproductive life. Two of the underlying conditions that may be present are endometriosis, a condition in which tissues of the uterine lining develop outside the uterus, and uterine fibroids, which are benign tumors that grow within the uterus.
Treatment of dysmenorrhea may require correction of any underlying condition, but in general it involves the adoption of healthy lifestyle practices and the use of heat, over-the-counter medications, nonsteroidal anti-inflammatory drugs or birth control pills.
By the end of this lesson, you should be able to:
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Back To CoursePathophysiology Textbook
20 chapters | 274 lessons