Dysmenorrhea or Painful Periods
More than half of the women have some pain during menses for 1 or 2 days; and usually the pain is mild. But for some women it is so severe that it prevents them from doing their normal activities.
Pain; in severe cases may be associated with diarrhea; nausea; vomiting; headache or dizziness.
TYPES OF DYSMENORRHEA OR PAINFUL PERIODS
There are two types of dysmenorrhea:
Primary dysmenorrhea: It is the cramping pain that happens before or during period.
Primary dysmenorrhea can begin soon after a girl starts having menstrual periods.
In many women with primary dysmenorrhea, periods become less painful as they get older. This type of period pain may also improve after giving birth
That is how if you are suffering from dysmenorrhea; you must have got this advice from your doctor that it will end as you grow.
Secondary dysmenorrhea: It is the pain that is caused by disorders of the reproductive tract.
The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. For example, the pain may begin a few days before a period starts. The pain may get worse as the period continues and may not go away after the period ends.
ICD-10 Codes for Dysmenorrhea (Painful Periods):
Dysmenorrhea refers to pain associated with menstruation. Relevant ICD-10 codes are:
- N94.4: Dysmenorrhea (painful menstruation)
- N94.4: Primary dysmenorrhea (painful menstruation not associated with pelvic pathology)
- N94.5: Secondary dysmenorrhea (painful menstruation associated with pelvic pathology)
CPT Codes for Diagnosis and Treatment of Dysmenorrhea:
Diagnosis and management of dysmenorrhea may involve several procedures:
- 99201 – 99215: Office or other outpatient visits (for evaluation, diagnosis, and follow-up care related to dysmenorrhea)
- 76830: Ultrasound, transvaginal (to evaluate pelvic organs for any abnormalities that may contribute to dysmenorrhea)
- 58100: Endometrial biopsy (if endometrial pathology is suspected as a cause of painful periods)
- 58558: Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C (for evaluating and treating endometrial conditions)
- 58662: Laparoscopy, surgical; with fulguration or excision of lesions (if surgical intervention is needed for conditions like endometriosis causing secondary dysmenorrhea)
- 58300: Endometrial biopsy (for diagnosing endometrial issues if relevant)
CAUSES OF PAINFUL PERIODS OR DYSMENORRHEA
Primary dysmenorrhea:
. It is caused by natural chemicals made by the uterus; called prostaglandins which cause the muscles and blood vessels of the uterus to contract. On the first day of the period; the level of prostaglandins is high; so the pain is maximum; and then it lessens after the first few days of the period.
Secondary dysmenorrhea?
Some of the conditions that can cause secondary dysmenorrhea include the following:
1.Endometriosis—Endometriosis happens when tissue similar to the lining of the uterus grows in other areas of the body, such as on the ovaries and fallopian tubes, behind the uterus, and on the bladder. Like the lining of the uterus, this tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially around the time of a period. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, also causing pain.
2.Fibroids—Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus. Fibroids located in the wall of the uterus can cause pain. Small fibroids usually do not cause pain.
3.Adenomyosis—Adenomyosis develops when tissue that normally lines the uterus begins to grow in the muscle wall of the uterus. This condition is more common in older women who have had children.
4.Problems with the uterus, fallopian tubes, and other reproductive organs—Certain defects or the abnormalities in the shape and size of uterus that a woman is born with can result in pain during menstruation.
5.Pelvic inflammatory diseases
6.Other conditions—Some medical conditions can flare up during a period and cause pain. These conditions include Crohn’s disease and urinary disorders.
HOW WILL I KNOW IF MY PAIN IS OF ANY CONCERN?
Yes, if you have painful periods requiring pain killers; you must see your gynecologist who will assess your pain. Your gynecologist may use Visual analog pain scale to assess the severity of your pain:
The visual analog scale (VAS) is
You will be asked to indicate your perceived pain intensity along a 10 cm horizontal line, and this rating is then measured from the left edge (=VAS score).
If needed, your ob-gyn may recommend a pelvic exam. A first step in treatment may be medications. If medications do not relieve your pain, treatment should focus on finding the cause of your pain.
Primary dysmenorrhea requires no specific treatment; and you need not worry much as you will stop getting the pain as you age and the severity of pain may become less.
Secondary dysmenorrhea must be addressed as early as possible to prevent any long term consequences .
DIAGNOSIS OF DYSMENORHEA
1. Careful history taking by your gynecologist and detecting anything abnormal.
2. Physical examination by your gynecologist
3. Ultrasonography to assess the cause of pain like fibroid; chocolate cyst or adenomyosis
4. Laparoscopy is often done to view the organs in the pelvis to diagnosis endometriosis as the cause of pain. Laparoscopy is a procedure in which a thin lighted telescope with camera is inserted through a tiny incision on the abdomen and all the organs are visually inspected for any abnormalities.
TREATMENT OF PAINFUL PERIODS OR DYSMENORRHEA
CONSERVATIVE TREATMENT:
1. Medicines: Medicines like ibuprofen; drotaverine; or naproxen are used as pain killers
2. Combined hormonal pills: They may be used in early endometriosis.
3. GnRh agonists like injection leuprolide depot may be used in cases of endometriosis or fibroids.
4. Hormonal intrauterine device like MIRENA may be inserted.
5. If a fibroid is present;
a. medications to control its size; like misoprostol 10;25
b. HIFU treatment (high Intensity Focused Ultrasound)
c. uterine artery embolization
SURGICAL TREATMENT:
1. If the cause of dysmenorrhea is chocolate cyst or endometriosis; laparoscopy is advised to excise the chocolate cysts and ablation and removal of tissues having endometriosis
2. If a uterine fibroid(s) is causing pain; surgical option is either myomectomy which may be performed by laparoscopy or hysterectomy if necessary
3. If adenomyosis is the cause of pain; either adenomyosis excision which may be done laparoscopically
4. Hysterectomy is done if severe pain associated with bleeding is present and if the child bearing is completed with no further desire of fertility in extreme cases having fibroids; severe endometriosis or adenomyosis
ALTERNATIVE TREATMENTS AND HOME REMEDIES FOR DYSMENORRHEA OR PAINFUL PERIODS
Accupuncture
Accupressure
Physical therapies that ease the trigger points
Relaxation
Cessation of smoking
Exercises
Heat application Practising yoga or meditation.