​Dysmenorrhoea​​

Dysmenorrhoea is defined as painful menstruation. It is the pain felt in your lower abdomen just before or during periods, produced by the contraction of your uterus. As part of the normal menstrual cycle, the uterus squeezes out the build-up of tissue inside when it does not receive a fertilized egg, which is witnessed in the form of bleeding. However, at times it can be a sign of an underlying disorder. Thus it is divided into two types:

1. Primary Dysmenorrhoea – is in the absence of organic disease. This is the commonly experienced ‘menstrual cramps’ which have a cyclic nature corresponding to monthly periods. The uterus is a muscular organ with blood vessels penetrating the walls. When it contracts so strongly that it temporarily blocks its own blood (and oxygen) supply, pain ensues. 

Menstrual cramps usually get milder with age and after having a child. Thus, being under 30 years of age and never having been pregnant, are risk factors for dysmenorrhea. Additionally, smoking, alcohol intake during menses, having a family history, reaching puberty early (at or before 11 years of age), experiencing heavy and/or irregular bleeding during periods also increase your chances of painful menstruation.​

2. Secondary Dysmenorrhoea – is pain acquired due to a medical disease of the reproductive system. Causes include:

  •     Adenomyosis (internal lining of uterus grows into its muscular wall)

  •     Uterine polyp

  •     Fibroids

  •     Ovarian cyst

  •     Cervical stenosis (small opening of cervix impeding outflow of blood)

  •     Pelvic Inflammatory disorder

  •     Copper IUD (a small wire like structure inserted into uterus for birth control)

  •     Abnormal pregnancy (miscarriage, ectopic)​

Some ladies have a bearable pain each month while others may go through severe discomfort. The following complaints may seem familiar if you are suffering from primary dysmenorrhoea:   

  • Intense cramping pain in lower belly

  • Dull, constant ache

  • Pain spreads to lower back, genital area and thighs

  • Nausea and/or vomiting

  • Change in bowel habits (like diarrhoea)

  • Fatigue

  • Headaches

You may have secondary dysmenorrhoea if you experience the following symptoms:

  • Abdominal pain during menstruation in your 20s or 30s, after having periods with no or minimal pain previously

  • Irregular bleeding

  • Poor response to oral contraceptives

  • Infertility

  • Vaginal discharge

If your menstrual cramps started with your first period and subsequently occur every month, it is likely that there is nothing to worry about. However, it is recommended that you make an appointment with the medical faculty at the Women’s Health Care Service Line​ at The Aga Khan University Hospital if you notice:

  • Such pain for the first time (not having felt it before with menses), especially after 25 years age
  • Symptoms are getting worse

  • Dealing with these complaints negatively affects your academic, professional or social life

  • Painful intercourse

  • Abnormal bleeding (heavy or irregular)

Certain causative disorders can lead to complications. Endometriosis may bring about infertility and pelvic inflammatory disease can cause internal scarring which raises the chances of ectopic pregnancy. Consequently, it is important to seek medical attention early for adequate treatment.

Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​

There are no tests specific to the diagnosis of primary dysmenorrhoea.

In the attempts to diagnose secondary dysmenorrhoea, your assessment will begin with a discussion regarding your complaints, followed by a physical examination of the abdomen and pelvis. Further testing may be required to accurately evaluate the cause. These tests may include:

  • Ultrasound: to examine the uterus and the surrounding structures in detail
  • Computerized Tomography (CT) scan or Magnetic Resonance Imaging (MRI): to get detailed pictures of the

  • Laparoscopy: direct visualization of internal structures with a thin tube attached to a tiny camera, inserted into abdomen via minute cut in the abdomen

  • Hysteroscopy: a thin instrument mounted with a camera will be inserted through the vagina to look at the cervix and uterus form inside.

In primary dysmenorrhoea, treatment will be targeted towards managing your symptoms. Your doctor​ may prescribe:

  • Dietary advice
  • Exercise regimen

  • Oral painkillers

  • Birth control pills

  • Hormonal therapy (injection/patch etcetera)


If a secondary cause is suspected, the relevant plan to address the underlying cause will be discussed with you. At times, surgical removal of the internal lining of the uterus (endometrial ablation/resection) or complete removal of uterus (hysterectomy) may be necessary.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited ​​to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.