Menstrual Disorders - Highlights

Highlights

Dysmenorrhea Risk Factors

A 2006 review in the British Medical Journal identified risk factors for painful menstrual periods (dysmenorrhea). Risk factors included:

• Younger age (less than 30 years old)
• Younger age (less than 12 years old) at first menstruation
• Longer and heavier periods
• Lower body mass index (less body fat)
• Smoking
• Never having children
• History of pelvic inflammatory disease
• History of sexual abuse or psychological problems

Factors that reduced the risk for dysmenorrhea included:

• Younger age at first childbirth
• Exercise
• Oral contraceptive use

Menorrhagia and Migraine

Women who suffer from migraine headaches may be more likely to experience heavy menstrual bleeding (menorrhagia) and endometriosis than women who do not get migraines. In a small study, women with migraines reported that menorrhagia significantly interfered with their quality of life.

Drugs Versus Surgery

• The levonorgestrel-releasing intrauterine system (LNG-IUS) is an intrauterine device (IUD) that is used for menorrhagia as well as birth control. Many experts recommend the LNG-IUS as an alternative to surgery for women with heavy bleeding. A 2006 review reported that women who used the LNG-IUS were as satisfied with their quality of life as women who chose surgery.
• Oral contraceptives (OCs) do not appear to work as well as surgery for controlling menorrhagia. In a comparison of OCs versus surgery, 58% of women who used birth control pills opted for surgery after 2 years.

Surgery

• Destruction of the endometrial lining (endometrial ablation) is a treatment option for menorrhagia. A review of newer types of endometrial ablation techniques found that they compared favorably with older types of surgery. Surgery time and complications were generally reduced.
• Nerve destruction surgery should not be recommended for dysmenorrhea, according to a review in the Cochrane Database. There is not enough evidence to support its use.

Review Date: 06/11/2006
Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital