Dysmenorrhea is defined as the cramping or throbbing pain in the lower abdominal area (pelvic area) experienced by women during menstrual bleeding. In many women this type of pain may occur even before the menstrual bleeding starts. The severity of dysmenorrhea varies from person to person; in some the pain is so severe that it becomes almost impossible to continue even daily life while in some it appears only little bit annoying. Other than cramping nature, pain could be burning, stabbing, shooting, nauseating or sharp in nature
Sometimes the underlying cause of dysmenorrhea can be identified as in women suffering from endometriosis, uterine fibroids etc. however, in some women no such underlying cause can be identified (primary dysmenorrhea).
Treatment options include relief of symptoms by administering pain killers, hormonal birth control pills, etc. and surgical management of underlying cause, if any. The severity of pain tends to decrease after giving birth especially in women suffering from primary dysmenorrhea.
Symptoms
Common presenting symptoms of dysmenorrheal include cramping or throbbing in the lower part of the abdomen, which varies in severity from person to person, sometimes the pain may present as a constant dull ache. In many women along with pain other symptoms like nausea, headache, passage of loose stool, lightheadedness may accompany.
As such dysmenorrheal does not cause any other health related complications, but severe degree of pain may interfere with normal day to day activities like interruption of routine life at school, workplace, etc.
However, in women with underlying gynecological problems certain complications may arise; as endometriosis may lead to infertility, pelvic inflammatory disease may lead to adhesion and scar tissue formation around the reproductive organs in the lower abdominal area and infertility or increased risk of ectopic pregnancy (implantation of the fertilized ovum outside the uterus) in the future.
Causes
During menstruation the uterus produces prostaglandins which are responsible for inflammatory changes and contraction of the uterine muscles and thus for pain. The amount of prostaglandin produced is directly proportional to the severity of pain.
Dysmenorrhea can be classified on the basis of underlying cause into two types namely primary and secondary. In primary dysmenorrhea no underlying cause can be identified, whereas in secondary dysmenorrheal several underlying gynecological conditions are responsible. These gynecological conditions include
1. Endometriosis: characterized by the presence of uterine endometrial tissue outside the uterus on other pelvic organs like the ovaries, fallopian tubes, the outer wall of the uterus, etc. This ectopic tissue seems to be responsive to the normal hormonal changes like the tissue located inside the uterus leading to bleeding from the ectopic sites and thereby causing symptoms
2. Fibroids: benign growth may arise from the walls of the uterus leading to number of symptoms including dysmenorrhea
3. Adenomyosis: in this condition the inner lining of the uterus, the endometrium invades the adjacent muscle layer, the myometrium and thus producing the symptoms
4. Pelvic inflammatory disease: this condition usually occurs following infection of the reproductive organs by the sexually transmitted infectious agents
5. Cervical stenosis: this is a structural abnormality where the outer opening of the cervix is so small that it obstructs the menstrual bleeding and thus blood collects in the uterine cavity. Increasing pressure of the collected blood may lead to dysmenorrhea

Risk factors
Common risk factors for dysmenorrhea include young age usually less than 30 years, having menstruation at an early age, excessive blood loss (menorrhegia), having irregular bleeding cycle (metrorrhegia), family history of dysmenorrhea, smoking, no history of pregnancy, etc.
Treatment
Treatment can be done in two ways; first by relieving the symptoms by pain killers, hormone containing contraceptives, etc. and surgery to manage the underlying cause as removal of fibroids (myomectomy), etc.