18.8 Dysmenorrhea

Painful menstruation that occurs in the absence of a physiologic cause is called dysmenorrhea. While many women experience some cramping and pain during menstruation, women with dysmenorrhea have severe pain that interferes with their daily life. This condition is further classified as primary dysmenorrhea (i.e., typical menstrual pain that occurs before or during a period and resolves within 12 to 72 hours of menstrual flow), or secondary dysmenorrhea (i.e., menstrual pain caused by an underlying condition such as endometriosis, pelvic inflammatory disease, or fibroids). Primary dysmenorrhea begins in the first few years after menarche, typically with the onset of regular ovulatory cycles.^[1],[2]

Primary dysmenorrhea is caused by the release of prοѕtаglаnԁins from endometrial sloughing as menstrual flow starts. Prostaglandins cause non-rhythmic uterine contractions, resulting in pain that may radiate to the lower back and thighs, as well as associated symptoms such as nausea, vomiting, fatigue, headache, and diarrhea.^[3],[4]

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, are prescribed as first-line pharmacologic treatment to inhibit prostaglandin synthesis and reduce pain. Hormonal therapies, such as combined oral contraceptives or progestins, may also be prescribed to reduce menstrual pain by suppressing ovulation and reducing endometrial proliferation. If medications do not sufficiently relieve pain, diagnostic testing such as pelvic ultrasound or diagnostic laparoscopy may be performed to visualize reproductive system anatomy and identify potential causes of secondary dysmenorrhea.^[5],[6]

For clients with continued menstrual pain despite using NSAIDs or oral contraceptives for six months, other medications may be prescribed called gonadotropin-releasing hormone analogs, including agonists (e.g., leuprolide acetate, nafarelin, goserelin) or antagonists (e.g., elagolix). Transcutaneous electrical nerve stimulation may also be prescribed for pain management.^[7]

Nonpharmacologic approaches can complement medical treatment and include heat therapy (e.g., a heating pad or a warm bath), relaxation techniques (e.g., deep breathing or guided imagery), exercise, and dietary modifications. Applying heat to the lower abdomen can help relax uterine muscles and reduce pain. Exercise, such as yoga or isometric exercises, and progressive relaxation can help manage stress and promote feelings of overall well-being. Research indicates dietary modifications such as a low-fat vegetarian diet; increased dairy intake; and supplements such as vitamin E, B1, B6, D, ginger powder, and fish oil may help reduce symptoms. Acupuncture may also be helpful in reducing dysmenorrhea, although research data is inconclusive.^[8],[9]

Nurses provide health teaching about dysmenorrhea and treatment options. They assess and document pain levels using validated pain scales and monitor the effectiveness of interventions. Nurses also provide emotional support and address clients’ anxiety or distress associated with dysmenorrhea by encouraging behavioral counseling and self-care practices. Behavioral counseling teaches clients strategies to modify the way they think about their pain and techniques to modify their response to раiո.^[10],[11]