Physician's Weekly
November 18, 2022
Painful Menstrual Periods – Dysmenorrhea

Q: I’m 36, and every month I have bad period pains. Any suggestions?

Dysmenorrhea is the medical term for painful periods. It is the most common gynecological condition in women. Far too often, the quality of life of the sufferer is negatively and significantly impacted, and this does not have to be the case.

Primary vs. Secondary Dysmenorrhea

Primary dysmenorrhea starts with the initial period (i.e. menarche) and reoccurs throughout reproductive life. The underlying pathology is an imbalance of the prostaglandins made in the lining of the womb (uterus) resulting in severe and abnormal contractions of the womb’s muscles and blood vessels. This pain usually lasts 24-72 hours and is often associated with fatigue, depression, headaches, dizziness, diarrhea, nausea, and vomiting.

Secondary dysmenorrhea begins sometime after having the first period and is caused by a new medical condition. This pain extends longer than primary dysmenorrhea and the aforementioned symptoms associated with primary dysmenorrhea are often absent.

Causes of secondary dysmenorrhea

  • Endometriosis – Tissue similar to the lining of the womb (endometrium) grows outside the womb and affects up to 10% of menstruating women.
  • Adenomyosis – The womb’s lining grows into its wall.
  • Fibroids
  • Pelvic Inflammatory Disease/ PID – A STD in the pelvis caused by a bacterium.
  • Ovarian cysts
  • Ectopic pregnancies and miscarriages
  • Cervical stenosis – i.e. a narrowed cervical canal

Associated symptoms

At the time of menstruation:

  • Severe cramping, throbbing, or aching in the lower abdomen and pelvic area.
  • Abdominal pressure.
  • Pain in the lower back, hips, and inner thighs.
  • Bloating, nausea, vomiting, diarrhea.
  • Extreme fatigue.
  • Dizziness & lightheadedness.
  • Headaches
  • Depression/ anxiety

Risk factors for the onset of dysmenorrhea

  • Women under the age of 25
  • Family history of dysmenorrhea
  • Heavy and or irregular periods
  • Depression/ anxiety
  • Overweight
  • First period before age 11
  • Smokers
  • Consuming alcohol or caffeine when having a period
  • Never been pregnant
  • History of sexual assault

Assessment

The doctor will take a thorough medical history and perform a complete physical and pelvic examination. Tests that may be ordered (if available) include:
Pelvic & Abdominal Ultrasounds.

  • MRI scan: Used to do a 3D radiological assessment of the pelvis.
  • Laparoscopy: An elongated flexible tube with an attached camera is used to directly visualize the organs in the pelvic and abdominal cavities while the patient is anesthetized.
  • Hysteroscopy: A specialized scope is inserted via the vagina to visualize the cervical canal and cavity of the womb.

Treatment options

  • Prostaglandin inhibitors: Nonsteroidal anti-inflammatory medications (NSAIDs) – e.g. Aleve, ibuprofen, diclofenac, Voltaren, Cataflam, Naprosyn, etc. These can significantly reduce pain, especially if started shortly before the pain starts. May not be needed for more than 2-3 days.
  • Paracetamol
  • Oral contraceptive pill
  • Progesterone (tablets or injections)
  • Diet – Increase consumption of vegetables, fruit, whole grains, legumes, and nuts in general.
  • Stop smoking
  • Avoid alcohol and caffeine when menstruating
  • Massages of the abdomen and lower back
  • Regular exercise
  • Heat applied to the abdomen and lower back
  • Dietary supplements – Omega 3, magnesium, and vitamins B-1, B-6, E, may help
  • Reducing stress
  • Hysterectomy – The womb is surgically removed in instances where other treatments have failed or are contraindicated.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale. For appointments: [email protected], 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.