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February 10, 2012

Menstrual Cramps (cont.)

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What if the cramps are very severe?

If a woman's menstrual cramps are too severe to be managed by these strategies, her doctor might prescribe low doses of birth control pills (oral contraceptives) containing estrogen and progestin in a regular or extended cycle. This type of approach can prevent ovulation (the monthly release of an egg) and reduce the production of prostaglandins which, in turn, reduces the severity of cramping and causes a light menstrual flow.

Use of an IUD that releases small amounts of the progestin levonorgestrel directly into the uterine cavity, has been associated with a 50 percent reduction in the prevalence of menstrual cramps. In contrast, IUDs that do not contain hormones, such as those containing copper, may worsen menstrual cramps.

Are there surgical solutions?

In the past, many women with menstrual cramps had an operation known as a D & C (dilation and curettage) to remove some of the lining of the uterus. This procedure is also sometimes used as a diagnostic measure to detect cancer or precancerous conditions of the uterine lining. Some women even resorted to the ultimate solution to menstrual problems by having a hysterectomy, surgery that removes the entire uterus.

Today, when a woman has abnormally heavy and painful uterine bleeding, her doctor may recommend endometrial ablation, a procedure in which the lining of the uterus is burned away or vaporized using a heat-generating device.

What is the treatment of secondary dysmenorrhea?

The treatment of secondary dysmenorrhea depends on its cause. There are a number of underlying conditions which can contribute to the pain including:

  • endometriosis (cells from the uterine lining tare located in other areas of the body);
  • uterine fibroids (non-cancerous uterine growths that respond to estrogen levels);
  • adenomyosis (a benign condition in which the cells of the inner uterine lining invade its muscular wall, the myometrium);
  • pelvic inflammatory disease (PID);
  • Adhesions (abnormal fibrous attachments between organs); or
  • use of an intrauterine device (IUD) for contraception.

All of these conditions should be first diagnosed by a physician who will then recommend the optimal treatment.

If a woman begins to experience changes in her menstrual cramps, such as in their severity, timing, or location, she should consult her physician, especially if the changes are of sudden onset.


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