Many girls and women have abdominal cramps and pain during their menstrual period, which the nonprofessionals refer to as menstrual pain or period pain. In medical terms, it is referred to as dysmenorrhea, which is a Greek term for painful monthly bleeding.
Menstruation or the monthly period is normal bleeding per vagina that happens towards the end of the woman’s monthly or menstrual cycle. Many women have recurrent lower abdominal pain during their periods every month. It may radiate to the inner thighs and back.
The pain is often a throbbing, cramping pain in the lower abdomen, which may be accompanied by other symptoms such as lower back pain, nausea, diarrhea, and headaches.
The pain is usually very severe as to negatively impact the patient emotionally, psychologically, and functionally and makes the woman seek immediate relief.
How common is it?
Period pain is a very common gynecologic problem. About 80% of women experience period pain at some phase of their life. About half report that the pain occurs during every period, and the other half report the pain occurring during some periods.
The period pain can start from the early teens and extend right up to the menopause. Most women complain of mild discomfort during menstruation, especially on the first day. However, in about 10% of women, the pain is severe enough to disrupt their daily life activities during those one to three days every month.
What factors increase your risk of dysmenorrhea?
Associated factors of higher dysmenorrhea risk include the following:
Having your first menstrual cycle at a younger age (before the age of 11 years)
Having no live babies during reproductive years (nulliparity)
Having an unhealed cesarean scar
Family history of dysmenorrhea
Types of dysmenorrhea, their causes and symptoms
Period pain or dysmenorrhea is of two types: primary dysmenorrhea and secondary dysmenorrhea, each type due to different causes.
Primary dysmenorrhea
Primary dysmenorrhea classically onsets within about 2 years of the beginning of the menstruation period in the teenage girl. The monthly cyclical pain starts within a few hours of the beginning of the period and usually goes away within 72 hours, only to reappear during the next monthly period.
Primary dysmenorrhea is the most common type of menstrual pain and comes before or during a period. It is not caused by another underlying pathological condition. It usually begins from the time of your first menstrual period or can begin after a few years.
Studies have shown the prevalence of primary dysmenorrhea in adolescents to be 80%. About half of them suffer from severe pain (dysmenorrhea). About 30% of women with primary dysmenorrhea are associated with significant impairment in quality of life.
Symptoms of primary dysmenorrhea
The pain develops in the midline of the pelvis and may radiate to the lower back or the inner part of your upper thighs. It may be constant of a cramping and gripping type, or it is episodic and patients often describe it as abdominal or pelvic cramps.
The pain is usually similar during each monthly period. The menstrual pain starts a day or two before your period, peaks 24 hours after the onset of your period, and continues until the period stops. In some cases, it can continue for a few more days.
In primary dysmenorrhea, the period pain often onsets when you are younger, just after you start getting periods. It is usually worse in women below the age of 20. The intensity of the pain often decreases as you get older and may go away after you have given birth to a baby.
Other associated symptoms may include nausea, vomiting, headaches, giddiness, tiredness, and sleeplessness.
Causes of primary dysmenorrhea
The main cause of primary dysmenorrhea are the naturally occurring hormone-like compounds in our body called prostaglandins that are produced and secreted by the inner lining of the uterus (endometrium).
Prostaglandins cause the blood vessels of the uterus to dilate and uterine smooth muscles to contract and relax. Women with primary dysmenorrhea tend to have higher levels of prostaglandins, causing the uterine contractions to be stronger and painful.
Prostaglandins also increase sensitivity to pain. Higher levels of prostaglandins have been found in the menstrual fluid and endometrial tissue of women with dysmenorrhea This is what causes abdominal cramps of primary dysmenorrhea.
These uterine contractions help release the endometrium (uterine lining) from the wall of the uterus, thus producing a period.
The level of prostaglandins is highest on the first day of a period. As the period continues and the endometrium is shed, the level comes down. This is why period pain lessens after the first few days of a period.
Treatment
Non-steroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory painkillers and give immediate relief from period pain. They include drugs like diclofenac and naproxen. They act by decreasing intrauterine pressure and inhibiting the production of prostaglandins.
Some advocate the use of oral contraceptive pills for primary dysmenorrhea. Oral birth control pills contain hormones that thin the endometrium and reduce the secretion of prostaglandins. They also prevent ovulation and by this dual action, they reduce the intensity of menstrual cramps. These hormones can also be delivered as an injection, a skin patch, a birth control implant placed under the skin of your upper arm, or an intrauterine device (IUD). However, there is limited evidence of their effectiveness.
Some home remedies that can help are using a hot water bottle or heat pack on the lower abdomen, moderate physical activity, and relaxation techniques.
Prevention tips include regular moderate physical activity, reducing stress levels with meditation and yoga, and not smoking.
If the intensity of the pain is not relieved by medication, you should see your gynecologist.
Secondary dysmenorrhea
The second type of period pain is called secondary dysmenorrhea.
Symptoms
Symptoms of secondary dysmenorrhea differ from those of primary dysmenorrhea in that they often start later in life.
It can affect women at any time after the onset of the first period or it can even be a new symptom for females after their 30s or 40s.
Sometimes, it may begin even before your first period if you have a pelvic problem at that age and can continue even after menopause. The pelvic pain often gets worse with time.
Secondary dysmenorrhea can be associated with varying intensities of pain and the intensity depends on the cause.
Women with secondary dysmenorrhea are usually older. Other associated symptoms and signs include heavy or prolonged menstrual bleeding, passing blood clots, bleeding in between periods, whitish gray vaginal discharge with a foul odor, painful and frequent urination, painful sex, and post-coital bleeding.
Women suffering from this type of period pain often do not respond satisfactorily to NSAIDs.
Causes
Secondary dysmenorrhea is due to an underlying pathological disease or disorder or a structural abnormality of the uterus. Such causes include:
Endometriosis is a pathological condition or a disease in which tissue cells similar to the innermost lining of the uterus (endometrium) grow outside the uterus most commonly on fallopian tubes and ovaries. Endometriosis can cause painful and heavy periods and makes it difficult to get pregnant. Endometriosis can begin during the woman’s first menstrual period and can last until menopause.
Adenomyosis is a gynecologic condition in which endometrial tissue grows into the muscular wall of the uterus. It enlarges the uterus and can cause very heavy menstrual bleeding, painful periods, and painful sex. It can often come after years of no symptoms.
Pelvic inflammatory disease develops when an infection from the vagina spreads inwards to one or more upper reproductive organs such as the uterus, fallopian tubes, or ovaries. It is usually caused by an untreated sexually transmitted infection such as chlamydia or gonorrhea. Most symptoms are mild and can include pelvic pain, painful sex, and painful urination.
Noncancerous uterine growths (fibroids) are common growths within the muscular wall of the uterus. They can cause heavy bleeding. Many people who have uterine fibroids do not have any symptoms. Symptoms depend on the location, size, and number of fibroids. The most common symptoms of uterine fibroids include painful periods with heavy menstrual bleeding.
Cervical stenosis is the narrowing of the cervical opening of the uterus. This impedes the menstrual flow during the periods causing a painful increase of intrauterine pressure.
Dislodged intrauterine device can cause temporary dysmenorrhea, which gets corrected on a gynecologist’s intervention
Other causes include endometrial polyps, cystitis, and in some women the use of an intrauterine contraceptive device.
Treatment
The treatment of secondary dysmenorrhea extends beyond taking just painkillers and may need further medical intervention in the form of blood and imaging tests, medication, and sometimes laparoscopy or open surgery.
Treatment options will depend on the cause of your secondary dysmenorrhea that has been diagnosed. For example, endometriosis and fibroids may need surgical removal of the uterus
When should I see my doctor for my period pain?
Mild to moderate menstrual pain or cramping is normal. The pain of primary dysmenorrhea should bother you and you will get relief with medication. The pain of secondary dysmenorrhea will persist until the underlying cause is treated by your gynecologist.
The following signals should compel you to see the gynecologist:
NSAIDs and self-care measures don’t give relief and the pain interferes with your daily life
Your pain suddenly gets worse
You get abdominal cramps for the first time in your late twenties
Period pain is accompanied by fever
You get pelvic pain even outside your period days. This is not dysmenorrhea but could be something else.
