Menstrual Cramps (Dysmenorrhea)

What it is

Dysmenorrhea is menstrual cramping — pain in the lower abdomen that can radiate to the back and thighs and may come with nausea, diarrhea, headache and general malaise. Mild cramping is common, but pain that forces a woman to miss work or school, that does not improve with common painkillers, or that worsens over the years should not be considered normal. Primary dysmenorrhea is linked to the production of prostaglandins by the uterus and usually starts in adolescence; secondary dysmenorrhea is caused by conditions such as endometriosis, adenomyosis, fibroids and infections, and tends to appear later. The consultation investigates the characteristics of the pain, with a gynecological exam and ultrasound when necessary. Treatment may include correctly used anti-inflammatory drugs, hormonal methods that reduce flow and pain, local heat, physical activity and treatment of the underlying cause, when identified.

Most common symptoms

• Cramping pain in the lower abdomen during menstruation
• Pain that radiates to the lower back and thighs
• Nausea, vomiting or diarrhea in the first days of the period
• Headache and general malaise
• Pain that starts one or two days before menstruation
• Need to miss work or school because of the pain

Causes and risk factors

• Increased prostaglandin production by the uterus (primary dysmenorrhea)
• Endometriosis and adenomyosis
• Uterine fibroids and polyps
• Pelvic inflammatory disease and infections
• Use of the copper IUD
• Family history of severe cramps and early first period

How it is diagnosed

At the visit, your gynecologist asks when the cramping started, at what point in the cycle it appears, how long it lasts, where it radiates to, and what has already been tried for relief. She also looks into associated symptoms, such as pain during intercourse, bowel or urinary changes during the period, and difficulty becoming pregnant. The gynecological exam and transvaginal ultrasound help identify causes such as endometriosis, adenomyosis and fibroids. In selected cases, MRI or laparoscopy complete the investigation.

How we treat it at Femi Saúde

The first step is usually the guided use of anti-inflammatory drugs, started before or right at the onset of pain, along with local heat, regular physical activity and lifestyle adjustments. When cramping persists, the Femi Saúde gynecology team may recommend hormonal methods that reduce flow and pain, such as hormonal contraceptives, progestins or the hormonal IUD. Pelvic physical therapy can help relax the muscles and manage the pain. If the investigation identifies a specific cause, such as endometriosis or fibroids, treatment is directed at it, including laparoscopy or hysteroscopy when indicated. The plan is individualized and adjusted over the course of follow-up.

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