What Is Dysmenorrhea?

Are your periods just the worst?  Or getting worse?

Period pain is called dysmenorrhea. More than half of people who have periods have some pain for 1 to 2 days each month. Usually, the pain is mild. But for some, the pain is so severe that it keeps them from participating in their normal activities for multiple days a month.

Primary dysmenorrhea is the pain that comes before or during a period. This pain is caused by chemicals called prostaglandins that are made in the lining of the uterus. Prostaglandins cause the muscles of the uterus to contract. On the first day of a period, the level of prostaglandins is high. As bleeding continues and the lining of the uterus is shed, the prostaglandin level goes down. This is why pain tends to improve after the first few days of a period. Primary dysmenorrhea begins soon after someone starts having periods. In many people with primary dysmenorrhea, periods become less painful as they get older and may improve after giving birth.

Secondary dysmenorrhea is caused by a disorder of the reproductive organs. The pain tends to worsen over time and it often lasts longer than normal menstrual cramps. The pain may begin a few days before a period starts, get worse as the period continues and may not go away after it ends.

Some of the conditions that can cause secondary dysmenorrhea include the following:

• Endometriosis - Endometriosis happens when tissue similar to the lining of the uterus grows in other areas of the body, such as on the ovaries and fallopian tubes, behind the uterus, and on the bladder. Like the lining of the uterus, this tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially around the time of a period. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, also causing pain. (See our blog post on endometriosis)
• Fibroids - Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus. Fibroids located in the wall of the uterus can cause pain. Small fibroids usually do not cause pain. (See our blog post on uterine fibroids).
• Adenomyosis - Adenomyosis develops when tissue that normally lines the uterus begins to grow in the muscle wall of the uterus. This condition is more common in older women who have had children.
• Problems with the uterus, fallopian tubes, and other reproductive organs - Certain defects that a woman is born with can result in pain during menstruation.
• Other conditions—Some medical conditions can flare up during a period and cause pain. These conditions include Crohn’s disease and urinary disorders.

 Treatment options for dysmenorrhea differ depending on the cause and severity.  

 There are a few non-pharmaceutical options:

• Acupuncture, acupressure, and nerve stimulation therapies may be useful for treating painful periods.
• Physical therapy that eases trigger points also may help with pain.
• Exercising most days of the week can make you feel better. Aerobic workouts, such as walking, jogging, biking, or swimming, help produce chemicals that block pain.
• Applying heat by taking a warm bath or placing a heating pad or hot water bottle on your abdomen can be soothing.
• Getting enough sleep before and during your period is important. Being well rested can help you cope with discomfort.
• Relaxing through meditation or practicing yoga also can help you cope with pain.

 There are also hormonal and non-hormonal medication options:

• Non-hormonal options include anti-inflammatory medications (NSAIDs) like Naproxen and Ibuprofen which can help with pain.
• Hormonal medications include hormonal contraceptives -  Combined hormonal contraceptives like the pill, contraceptive patch and contraceptive ring and progestin-only options like hormonal IUDs, the Depo Provera shot and the contraceptive implant. These can help manage heavy periods by making them lighter or stopping them altogether which can result in reduction of pain.

 ***There has been some discussion about Vitamin B1, magnesium and omega-3 fatty acid supplements being helpful, but not enough research has been done to recommend them as effective treatments for period pain.***

If you’ve been experiencing dysmenorrhea that disrupts your life or are experiencing worsening dysmenorrhea as you’ve gotten older, talk to your healthcare provider for an assessment.  Painful periods may be common, but they severe pain isn't normal and management of your pain is possible.

Source: The American College of Obstetricians and Gynecologists (acog.org)