Dysmenorrhea can be literally translated as "difficult monthly flow." Although it's normal for most women to have mild abdominal cramps on the first day or two of their period, about 10% of women experience severe pain.

There are two types of dysmenorrhea:

• Primary dysmenorrhea is menstrual pain that's not a symptom of an underlying gynecologic disorder but related to the normal process of menstruation. Primary dysmenorrhea is common, affecting more than 50% of women, and quite severe in about 10%. This is the most common type of dysmenorrhea.
• Secondary dysmenorrhea is menstrual pain that's related to some kind of gynecologic disorder.

Dysmenorrhea is more likely to affect girls during adolescence. Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. At some time, more than half of all teenage girls and young women experience dysmenorrhea.

Primary dysmenorrhea is painful and sometimes debilitating for brief periods of time, but it's not harmful. Although secondary dysmenorrhea, can be associated with gynecological conditions, most of these can be easily treated.

Primary dysmenorrhea is thought to be caused by excessive levels of prostaglandins, hormones that make your uterus contract during menstruation and childbirth. Its pain probably results from contractions of your uterus that occur when the blood supply to its lining (endometrium) is reduced. Usually, the pain will happen only during menstrual cycles in which an egg is released. The pain may progressively become worse as endometrial tissue shed during a menstrual period passes through the cervix, particularly when the cervical canal is narrow.

Other factors that may make the pain of primary dysmenorrhea even worse include a uterus that tilts backward (retroverted uterus) instead of forward, lack of exercise, and psychological or social stress.

Secondary dysmenorrhea may be caused by a number of conditions, including:

• fibroids - benign tumours that develop within the uterine wall or are attached to it
• adenomyosis - the tissue that lines the uterus (called the endometrium) begins to grow within its muscular walls
• a sexually transmitted disease (STD)
• endometriosis - fragments of the endometrial lining escape the uterus and become implanted on other pelvic organs
• pelvic inflammatory disease (PID), which is primarily an infection of the fallopian tubes, but can also affect the ovaries, uterus, and cervix
• an ovarian cyst or tumour

The main symptom of dysmenorrhea is pain. It occurs in your lower abdomen during menstruation and may also be felt in your hips, lower back, or thighs. Other symptoms may include nausea, vomiting, diarrhea, lightheadedness, or general aching. For most women, the pain usually starts shortly before or during their menstrual period, peaks after 24 hours, and subsides after 2 days. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain.

Dysmenorrhea pain may be spasmodic (sharp pelvic cramps at the start of menstrual flow) or congestive (deep, dull ache). The symptoms of secondary dysmenorrhea often start sooner in the menstrual cycle than those of primary dysmenorrhea, and usually last longer.

If you experience painful periods, check work with your doctor to see whether you might have an underlying disorder that is causing secondary dysmenorrhea. You may be given a pelvic examination, and your blood and urine may be tested. A doctor may also wish to use ultrasound to get a picture of your internal organs or even use the technique of laparoscopy for a direct look into your uterus.

Your doctor may prescribe hormone supplements or other remedies depending on the cause of the dysmenorrhea.

Primary dysmenorrhea is usually treated by medication such as an analgesic drug. Many women find relief with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, and acetylsalicylic acid (ASA)*. Oral contraceptives also may also help reduce the severity of the symptoms. Nausea and vomiting may be relieved with an anti-nausea (antiemetic) medication, but these symptoms usually disappear without treatment as cramps subside.

Treatment for secondary dysmenorrhea will vary with the underlying cause. Surgery can be done to remove fibroids or to widen the cervical canal if it is too narrow. If treatment isn't successful and the pain is extreme, you may consider surgery that severs the nerves to the uterus. This can help; however, complications may arise due to injury to nearby organs.

In addition to the above, other non-medicinal treatments for the pain of dysmenorrhea include:

• lying on your back, supporting your knees with a pillow
• holding a heating pad or hot-water bottle on your abdomen or lower back
• taking a warm bath
• gently massaging your abdomen
• doing mild exercises like stretching, walking or biking - exercise may improve blood flow and reduce pelvic pain
• getting plenty of rest and avoiding stressful situations as your period approaches

You may also wish to consider alternative therapies such as hypnosis, herbal medications, or acupuncture. Be cautious with herbal medications. They may be "natural", but they are not necessarily safe or free of side effects. They can also interact with other medications you may be taking. Check with your doctor or pharmacist before trying any herbal medications.

*All medications have both common (generic) and brand names. The brand name is what a specific manufacturer calls the product (e.g., Tylenol®. The common name is the medical name for the medication (e.g., acetaminophen). A medication may have many brand names, but only one common name. This article lists medications by their common names. For more information on brand names, speak with your doctor or pharmacist.