Menstruation: Severe Cramps (Dysmenorrhea)

Description

Alternative Names

Causes

Contraction-Causing Chemicals. Primary dysmenorrhea is associated with powerful chemicals known as prostaglandins and arachidonic acid, which induce uterine muscle (myometrium) contractions. (Dysmenorrhea also often accompanies heavy bleeding, in which prostaglandins also play a large role.)

Abnormal Nervous System Response. Research suggests that some women with primary dysmenorrhea may have autonomic nervous systems that are overly sensitive to menstrual cycle changes. The autonomic nervous system regulates the heart rate, blood pressure, and it contains the pain receptors in nerve fibers in the uterus and pelvic area. As a result, women with autonomic nervous system abnormalities may have a more intense response to pain than others.

Abnormalities in the Arteries in the Uterus. Studies using a special imaging technique called Doppler ultrasound report impaired blood flow through the arteries in the uterus in women with severe dysmenorrhea.

Genetic Factors. Genetic factors may play a critical role in over half of primary dysmenorrhea cases. For example, two researchers in China have identified genetic factors called cytochrome P450 2D6 (CYP1D6) and glutathione S-transferase Mu (GASTM1). They regulate a number of enzymes, and when they occur together these genetic factors are associated with recurrent primary dysmenorrhea.

Causes of Secondary Dysmenorrhea

Endometriosis. Secondary dysmenorrhea occurs with other medical conditions, particularly endometriosis. In one study of adolescents, endometriosis was the most common cause of menstrual pain that did not respond to over-the-counter painkillers. Endometriosis is a chronic and often progressive disease that develops when fragments of endometrial tissue become implanted outside the uterine cavity, usually in other areas of the pelvis. This condition is discussed in another report.

Endometriosis is the condition in which the tissue that normally lines the uterus (endometrium) grows on other areas of the body causing pain and irregular bleeding.

Other Conditions. The use of an intrauterine device (IUD) or the presence of pelvic inflammatory disease (PID), uterine fibroids, miscarriage, ectopic pregnancy, uterine polyps, or cancer can also cause pain.