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  • Overview

    For girls of any age, the menstrual period is a time well known for cramping—dull, throbbing or squeezing pains in the lower abdomen. For one girl, these aches may be mildly annoying and no cause for concern, but for another, the discomfort may be so severe she has to stay home from work or school. Debilitating menstrual cramping is called dysmenorrhea.

    • Primary dysmenorrhea is a term describing severe menstrual cramping that has always joined a woman's menstruation.
    • Secondary dysmenorrhea is a term describing menstrual cramping that develops because of some other condition, such as endometriosis or ovarian tumors.

    How Boston Children's Hospital approaches dysmenorrhea

    At the Gynecology Program at Boston Children's Hospital, we understand the seriousness of severe menstrual cramps. Our experienced physicians will work with your daughter to provide an accurate diagnosis and treatment of the problem underlying her dysmenorrhea.

    The Center for Young Women's Health provides extensive and easy to access information for girls with questions about her menstrual cycle. The following guide may be helpful to her: Puberty and Your Menstrual Cycle: A Guide for Teens.

    Contact Us

    Children's Hospital Boston
    333 Longwood Avenue
    Across from the Main Hospital
    Boston MA 02115


  • In-Depth

    What are the symptoms of dysmenorrhea?

    Every young woman experiences dysmenorrhea differently. Some common symptoms include:

    • dull, throbbing or cramping pain in her lower abdomen
    • pain that radiates to her lower back and thighs
    • nausea and vomiting
    • loose stools
    • sweating
    • dizziness

    What causes dysmenorrhea?

    When menstruation happens, your uterus contracts to oust its lining. Hormone-like substances, particularly prostaglandin and arachidonic acid, trigger these contractions. Young women with primary amenorrhea experience abnormal uterine contraction as a result of an imbalance of those chemicals.

    Secondary amenorrhea is caused by other conditions. Common conditions include:

    • endometriosis
      • This condition is the most common causes of secondary amenorrhea.
      • When the endometrium, the normal lining of the uterus, grows in other places, it continues its normal menstrual duties of thickening, breaking down and bleeding away each month. Since there is nowhere for this blood to go, it stays trapped in the body, and can cause painful cysts, cramping and scar tissue.
    • pelvic inflammatory disease (PID)
      • Usually caused by sexually transmitted bacteria
    • uterine fibroids
    • abnormal pregnancy (i.e., miscarriage, ectopic)
    • infection, tumors, or other growths in the pelvic cavity
    • cervical stenosis
      • In some women, the opening of the cervix may be too small to accommodate the menstrual flow, causing pressure and pain in the uterus.

    Who is at risk for dysmenorrhea?

    Any young woman can develop dysmenorrhea, but factors that may predispose her include:

  • Tests

    How is dysmenorrhea diagnosed?

    When you or your daughter suspects dysmenorrhea, a physician will evaluate her complete medical history and perform a pelvic examination. All menstrual disorders, conditions and medications that could be causing the problem need to be ruled out.

    In general, diagnostic measures for dysmenorrhea include:

    • ultrasound
    • magnetic resonance imaging
    • laparoscopy, a minor surgical procedure in which a physician looks inside the pelvic cavity with a small camera
    • hysteroscopy, a visual examination of the cervix and uterus using a tool called a hysteroscope
  • Dysmenorrhea treatment at Children's

    Your daughter's physician will counsel her on helpful stress management strategies. Girls with endometriosis should always help their bodies cope with pain by exercising regularly and following a healthy diet.

    Other treatments for managing dysmenorrhea include:

    • prostaglandin inhibitors (i.e., nonsteroidal anti-inflammatory medications, or NSAIDs, such as aspirin, ibuprofen) to reduce pain
    • acetaminophens
    • oral contraceptives (ovulation inhibitors)
    • progesterone treatment
    • dietary modifications to increase protein and decrease sugar and caffeine intake
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