Painful Menstrual Periods – Overview

The medical term for period pains is dysmenorrhea. Colloquially dysmenorrhea is often referred to as period cramps. Sufferers often describe such pain as moderate to severe and cramping in nature. It generally begins with or just before the period. In 10 per cent of instances, dysmenorrhea is severe enough to disrupt the woman’s lifestyle.

Up to 90 per cent of women experience some pain at the time of menstruation at some point in their lifetime. Dysmenorrhea is often categorized as primary or secondary.

Primary dysmenorrhea starts in adolescence, within three years of seeing the first period (menarche), and continues throughout the person’s reproductive life.
Generally, it becomes less painful with age. Primary dysmenorrhea results from severe and abnormal contractions of the womb (uterus). This pain usually last 12-72 hours. It may sometimes be associated with bloating, nausea, vomiting, fatigue, diarrhoea, irritability, and headache. This is more common in those who get their first period before the age of 12. Many report a reduction in the intensity of this dysmenorrhea after childbirth.

Secondary dysmenorrhea begins at a later point in life, for example in a woman’s 20s, 30s, and 40s, and is caused by a recently developed medical condition. This pain often lasts for several days, and usually is not associated with bloating, nausea, vomiting, fatigue, or diarrhoea. This type of dysmenorrhea tends to get worse over time.

Causes of dysmenorrhea

Chemical imbalance in the prostaglandins leading to abnormal contractions of the womb.

Endometriosis – This is where the lining of the womb (endometrium) is found inside of the wall of the womb (adenomyosis) or outside the womb.
Pelvic infections – (PID/ Pelvic Inflammatory Disease). This is caused by a bacterium – STIs/ STDs.
Fibroids.
Ectopic pregnancies and miscarriages.
Cervical stenosis (a narrowed cervical passage).
Tumours or polyps of the pelvis.
Chron’s disease.
Urinary disorders.

Symptoms associated with dysmenorrhea

The patient may experience:

Pains and cramping in the abdomen and pelvic area. This pain is often severe.
Pressure and or throbbing in the lower abdomen.
Pain in the hips, lower back, and inner thighs.
Bloating, nausea, vomiting, and diarrhoea.
Significant fatigue.
Light headedness and dizziness.
Headaches.
Occasionally constipation.
Increased frequency of urination.
Feeling tired.
Mood changes.

Which women are at the highest risk for dysmenorrhea?

Those under the age of 30.
Having a family history of painful periods.
Those with irregular and or heavy periods.
The overweight.
Those with pre-menstrual syndrome.
Those who started their periods before age 12.
Smokers.
Those who drink alcohol when having their period.
Those who have never been pregnant.
History of sexual abuse.
Those under stress or suffering from anxiety or depression.

How is dysmenorrhea assessed?

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

Pelvic & Abdominal Ultrasound.
MRI or CT scan: Either can be used to do a 3D radiological assessment of the pelvis.
Laparoscopy of the pelvis: An elongated flexible device with a camera attached is used to directly look, when the patient is anesthetized, at the organs in the pelvic cavity.
Hysteroscopy: A specialized scope is used to examine the cavity of the womb.

Treatment options for dysmenorrhea include:

Nonsteroidal anti-inflammatory medications (NSAIDs) – e.g. ibuprofen, diclofenac, Voltaren, Naprosyn, Aleve, etc. These inhibit prostaglandin synthesis and can significantly reduce pain, especially if taken shortly before the pain starts.
Paracetamol/ Acetaminophen.
Oral contraceptive pill.
Progesterone (tablets or injections or IUD).
Dietary modifications (reducing sugar and caffeine).
Avoid smoking and drinking alcohol.
Massages of the lower back and abdomen.
Regular exercise.
Heating pad across the abdomen.
Hot bath or shower.
Increasing the consumption of omega-3 fatty acids.
Using Vitamin D and magnesium supplements.
Hysterectomy (in extreme cases the surgical removal of the uterus).
Anxiety, depression, and stress, if present, should be treated.

When to see the doctor?

The pain is preventing you from performing daily tasks or causing you to miss school or work.
f the periods are heavy.
If there is spotting or bleeding between periods.
If there is bleeding after sex.
If there is an abnormal vaginal discharge or odour.
If sexual intercourse is painful.
Associated urinary frequency.
The pains are not responding to over-the-counter pain relievers.
If there is associated anxiety and or depression.

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 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.