Download Menstrual cramps

Menstrual disorders
Definition
A menstrual disorder is a physical or emotional problem that interferes with the normal
menstrual cycle, causing pain, unusually heavy or light bleeding, delayed menarche, or
missed periods.
Description
Typically, a woman of childbearing age should menstruate every 28 days or so unless she
is pregnant or moving into menopause. But numerous things can go wrong with the
normal menstrual cycle, some the result of physical causes, others emotional. These
include amenorrhea, or the cessation of menstruation, menorrhagia, or heavy bleeding,
and dysmenorrhea, or severe menstrual cramps. Nearly every woman will experience one
or more of these menstrual irregularities at some time in her life.
Dysmenorrhea
Characterized by menstrual cramps or painful periods, dysmenorrhea, which comes from
the Greek words for "painful flow," affects nearly every woman at some point in her life.
It is the most common reproductive problem in women, resulting in numerous days
absent from school, work, and other activities. There are two types: primary and
secondary.
Primary, or normal cramps, affects up to 90% of all women, usually occurring in women
about three years after they start menstruating and continuing through their mid-twenties
or until they have a child. About 10% of women who have this type of dysmenorrhea
cannot work, attend school, or participate in their normal activities. It may be
accompanied by backache, dizziness, headache, nausea, vomiting, diarrhea and tenseness.
The symptoms typically start a day or two before menstruation, usually ending when
menstruation actually begins. Primary dysmenorrhea is related to the production of
prostaglandins, natural chemicals the body makes that cause an inflammatory reaction.
They also cause the muscles of the uterus to contract, thus helping the uterus shed the
lining built up during the first part of a woman's cycle. Women with severe menstrual
pain have higher levels of prostaglandin in their menstrual blood than women who do not
have such pain. In some women, prostaglandins can cause some of the smooth muscles in
the gastrointestinal tract to contract, resulting in the nausea, vomiting and diarrhea some
women experience. Prostaglandins also cause the arteries and veins to expand, so that
blood collects in them rather than flowing freely through them, causing pain and
heaviness. Yet another reason for severe cramps, particularly in women who have not yet
had a baby, is that the flow of the blood and clots through the tiny cervical opening is
painful. After a woman has a baby, however, the cervix opening is larger.
Secondary dysmenorrhea has an underlying physical cause and primarily affects older
women, although it may also occur immediately after a woman begins menstruation.
Secondary dysmenorrhea is more serious and is related to some underlying cause. The
pain may feel like regular menstrual cramps, but may last longer than normal and occur
throughout the month. It may be stronger on one side of the body than the other. Possible
causes include:










A tipped uterus
Endometriosis, a condition in which the same type of tissue found in the lining of
the uterus occurs outside the uterus, usually elsewhere in the pelvic cavity
Adenomyosis, a condition in which the endometrial lining grows into the muscle
of the uterus
Fibroids
Pelvic inflammatory disease (PID)
An IUD
A uterine, ovarian, bowel or bladder tumor
Uterine polyps
Inflammatory bowel disease
Scarring or adhesions from earlier surgery
Primary dysmenorrhea is typically treated with nonsteroidal anti-inflammatory
medications like ibuprofen and naproxen, which studies show help 64 to 100% of
women. Birth control pills relieve pain and symptoms in about 90% of women by
suppressing ovulation and reducing the amount of menstrual blood. It may take up to
three cycles before a woman feels relief. Heat from a heating pad or hot bath, can also
help relieve pain.Treatment for secondary dysmenorrhea depends on the underlying cause
of the condition.
Menstrual cramps
Most women have experienced menstrual cramps before or during their period at some
point in their lives. For some, it's part of the regular monthly routine. But if your cramps
are especially painful and persistent, you should consult your health care professional.
Pain from menstrual cramps is caused by uterine contractions, triggered by
prostaglandins, hormone-like substances that circulate in your bloodstream. If you having
severe menstrual pain, you might also find you have some diarrhea or an occasional
feeling of faint where you suddenly become pale and sweaty. That's because
prostaglandins speed up contractions in your intestines, resulting in diarrhea, and lower
your blood pressure by relaxing blood vessels, leading to lightheadedness.
Premenstrual syndrome (PMS)
PMS is a term commonly used to describe a wide variety of severe physical and
psychological symptoms associated with the menstrual cycle. About 30 to 40 percent of
women experience symptoms severe enough to disrupt their lifestyles. PMS symptoms
are more severe and disruptive than the typical premenstrual symptoms that as many as
75 percent of all women experience.
There are more than 150 documented symptoms of PMS, the most common of which is
depression. Symptoms develop about seven to 10 days before your period and disappear
once your period begins or soon after.
Physical symptoms associated with PMS include:






Bloating
Swollen, painful breasts
Fatigue
Constipation
Headaches
Clumsiness
Emotional symptoms associated with PMS include:





Anger
Anxiety or confusion
Mood swings and tension
Crying and depression
An inability to concentrate
No one knows what causes PMS. However, researchers now know that it is not a simple
result of an imbalance of estrogen and progesterone—commonly referred to as "female
hormones," or any other single hormonal factor.
A complex interaction of brain chemicals (such as dopamine, norepinephrine and
serotonin) are now suspected of having a more direct relationship in triggering PMS.
Exactly how these brain chemicals change with or affect the menstrual cycle remains
unclear. Estrogen excesses, progesterone deficiencies, vitamin B6 deficiencies, low levels
of serotonin (a brain chemical that affects mood), an excess of prolactin (a protein
hormone that induces lactation) and altered glucose metabolism are among the many
different theories that attempt to explain PMS, but none has been proven.
PMS differs from other menstrual cycle symptoms because symptoms:



tend to increase in severity as the cycle progresses.
are relieved when menstrual flow begins or shortly after.
are present for at least three consecutive menstrual cycles.
Symptoms of PMS may worsen with age and increase in severity following each
pregnancy. If you experience PMS, you may have an increased sensitivity to alcohol at
specific times during your cycle. Women with this condition often have a sister or mother
who also suffers from PMS, suggesting a genetic component exists for the disorder.
Premenstrual dysphoric disorder (PMDD)
Premenstrual dysphoric disorder is far more severe than the typical PMS. Women who
experience PMDD (about 3 to 8 percent of all women) say it significantly interferes with
their lives. Experts equate the difference between PMS and PMDD to the difference
between a mild tension headache and a migraine.
The most common symptoms of PMDD are heightened irritability, anxiety and mood
swings. Women who have a history of major depression, postpartum depression or mood
disorders are at higher risk for PMDD than other women. Although some symptoms of
PMDD and major depression overlap, they are different:


PMDD-related symptoms (both emotional and physical) are cyclical. When a
woman starts her period, the symptoms subside within a few days.
Depression-related symptoms, however, are not associated with the menstrual
cycle. Without treatment, depressive mood disorders can persist for weeks,
months or years.
Amenorrhea
There are two types of amenorrhea: primary and secondary. Overall, they affect 2-5% of
childbearing women, a number that is considerably higher among female athletes
(possibly as high as 66%).
Primary amenorrhea occurs when a girl at least 16 years old is not menstruating. Young
girls may not have regular periods for their first year or two, or their periods may be very
light, a condition known as oligomenorrhea. A light flow is nothing to worry about. But if
the period has not begun at all by age 16, there may be something wrong. Amenorrhea is
most common in girls who are severely underweight and/or exercise intensely, both of
which affect the amount of body fat necessary to trigger the release of hormones that, in
turn, begins puberty.
Secondary amenorrhea occurs in women of childbearing age after a period of normal
menstruation and is diagnosed when menstruation has stopped for three months. It can
occur in women of any age.
Causes and symptoms
The only symptom of primary amenorrhea is delayed menstruation. In addition to low
body weight or excessive exercise, other causes of primary amenorrhea include Turner's
syndrome, a birth defect related to the reproductive system, or ovarian problems. In 2003,
a group of researchers reported on a new genetic mutation associated with primary
amenorrhea. In secondary amenorrhea, the primary symptom is the ceasing of
menstruation for at least three months. Causes include pregnancy or breastfeeding,
sudden weight loss or gain, intense exercise, stress, endocrine disorders affecting the
thyroid, pituitary or adrenal glands, including Cushing's Syndrome and hyperthyroidism,
problems with or surgery on the ovaries, including removal of the ovaries, cysts or
ovarian tumors.
Amenorrhea in athletes or dancers is frequently associated with two other disordersosteopenia, or reduced bone mass, and eating disorders. This combination is sometimes
called the female athlete triad. Osteopenia is of concern because it can lead to premature
osteoporosis.
Treatment
For primary amenorrhea with no underlying problem, no treatment is necessary, and a
wait-and-see approach is often adopted. If women have genetic or hormonal
abnormalities, amenorrhea is often treated with oral contraceptives that contain
combinations of estrogen and progestin. Side effects include bloating, weight gain and
acne, although some birth control pills actually improve acne. Progestins, or synthetic
progesterone, are also used alone to "jump start" a woman's period. They include
medroxyprogesterone (Provera, Amen, Depo-Provera), norethindrone acetate (Aygestin,
Norlutate), and norgestrel (Ovrel). If the amenorrhia is due to a physical problem, such as
a closed vagina, surgery may be required.
With secondary amenorrhia, treatment depends on the cause. Hormonal imbalances are
treated with supplemental hormones. Tumors or cysts may require surgery. Obesity may
require a diet and exercise regimen, while amenorrhia resulting from too much dieting or
exercise necessitates lifestyle changes.
Alternative treatment
There are several herbal remedies that can bring on menstruation, including: black
cohosh, cramp bark, chasteberry, celery, turmeric, and marsh mallow. Numerous
relaxation techniques, such as meditation, deep breathing, and yoga can help reduce
stress and its affects on menstruation.
Prevention
Simply following a healthy exercise and nutritional program can help prevent
amenorrhea, as can reducing stress and learning relaxation techniques. Also, avoiding
excessive alcohol intake and quitting smoking may prevent missed periods.