Painful Menses / Dysmenorrhea

Dysmenorrhea is the term used to describe painful menstruation, a condition that affects a large portion of the female population and virtually incapacitates some.

Of post-pubescent women, 52 percent suffer from dysmenorrhea; of those, 10 percent find it nearly, if not completely impossible to function for one to three days each month.

Dysmenorrhea is often confused with PMS. Although both may result in similar symptoms, the two are distinct and separate conditions. In contrast to sufferers of PMS, who get some relief with the onset of menstruation, a patient with dysmenorrhea feels worse once menstruation begins.

Primary dysmenorrhea, one of the two types of the condition, is menstrual pain in the absence of a pelvic pathological condition.

Secondary dysmenorrhea, in contrast, is the result of such a condition, including endometrial polyps, pelvic inflammatory disease, endometriosis, or submucous myomas. In girls, this type of dysmenorrhea may result from a uterine or vaginal anomaly with obstruction of menstrual outflow.


Symptoms of dysmenorrhea, which may begin a few hours or days before menstruation and can last up to two or three days, can include:

  • Pain over the lower abdomen, which may radiate to the front of the thighs
  • Low back pain
  • Nausea
  • Diarrhea
  • Headache
  • Fatigue
  • Loss of consciousness (syncope) and collapse

Swiss Ball Ab Exercise


Several theories regarding the cause of dysmenorrhea have been proposed, but no exact cause has been determined. Complicating matters, its cause may actually vary among women.

Psychological factors were once believed to be the primary cause of dysmenorrhea. Studies have failed to support this theory, however. Over the years, medical practitioners have come to believe that several factors play a role in dysmenorrhea.

Because dysmenorrhea occurs only during ovulatory cycles, the condition may be related to the release of hormones, such as Vasopressin. Vasopressin causes contractions of the uterus, which can result in cramps. The hormones estrogen and progesterone have also been suspected in dysmenorrhea.

Obstruction in the pelvis has also been examined as a cause of menstrual pain. Such obstruction can lead to retention of menstrual secretion, resulting in irritability and contractility in the pelvis because of chemicals in the retained fluid. The nerves in the uterus also may become more sensitized to stimuli.

The most commonly accepted theory involves prostaglandins, natural chemicals that are released by structures in the ovaries near the time of menstruation. Prostaglandins increase the activity of the musculature in the uterus, leading to contractions and cramping, and the obstruction of blood flow in the vessels to the tissue in the uterus. Pain results when this decreased blood flow causes swelling in the surrounding tissue.


Many patients do not report symptoms of dysmenorrhea because they are unaware that relief from pain is possible. Treatment is available, and has become more sophisticated and effective as research into causes continues.

Physical therapy offers options preferred by many women because of the non-narcotic and non-invasive nature of the techniques. Successful treatment options, which are available at Midwest Physical Therapy Services, may include:

  • Heat packs
  • Biofeedback methods
  • Relaxation techniques
  • TENS (Transcutaneous electrical nerve stimulation)

TENS, for example, is a non-invasive, non-narcotic procedure that has been used successfully in the control of post-operative pain, low-back pain, labor and delivery, and numerous other conditions. It is believed that this method works by causing the release of natural painkillers in the brain and body.

The physical therapists at Midwest Physical Therapy Services have been specifically trained in these treatment options. Your therapist will develop an individualized program for you, based on an intensive evaluation.

You can be assured that we at Midwest Physical Therapy Services will take your discomfort seriously. With proper treatment, you need not be disabled by dysmenorrhea.