Painful Menstruation: All You Need to Know

What is painful menstruation?

Menstruation is the shedding of the uterine lining once a month. It occurs as blood passing out through a small cervical opening and the vagina. Usually, painful menstruation or discomfort during menstrual periods is normal.

However, menstruation may be associated with excessive pain, causing absence from work or school. Pain occurs in the lower back and the lower abdomen. Usually, it occurs 1 to 2 days before menstruation and lasts 2 to 4 days.

Further, menstrual pain may range from dull to severe and extreme. It may begin after an egg is released from the ovaries and travels to the fallopian tube.

Types of painful menstruation

Painful menstruation is also called dysmenorrhea. It is of two main types namely: primary and secondary dysmenorrhea.

Primary dysmenorrhea

In primary dysmenorrhea, women experience pain before and during menstruation. In fact, the menstrual pain is associated with the normal process of menstruation.

Secondary dysmenorrhea

Secondary dysmenorrhea occurs in women who have experienced normal periods that become painful later in life. For example, conditions affecting pelvic organs such as uterine fibroids, pelvic inflammatory disease or endometriosis can cause secondary dysmenorrhea.

What are the causes of painful menstruation?

Causes of dysmenorrhea can be grouped into primary and secondary causes, as follows:

Primary causes of painful menstruation

Usually, painful menstrual periods do not have any identifiable cause. However, some women may have a higher risk for dysmenorrhea than others.

The risks for painful menstrual periods include:

• A family history of painful periods
• Age < 20 years
• Heavy bleeding with periods
• Smoking
• Puberty before the age of 11 years
• Irregular periods
• Having not had a baby

Prostaglandin is a hormone that stimulates muscle contractions in the uterus causing the expulsion of the lining. Of course, these uterine muscle contractions can cause pain and inflammation.

It is important to note that the level of prostaglandin rises before menstruation commences.

Secondary causes of painful menstruation

Painful menstruation can also result from underlying medical conditions. These conditions include:

Endometriosis

Endometriosis is a painful medical condition in which cells from the lining of the uterine cavity grow outside the uterus. For example, these cells may grow on the ovaries, fallopian tubes or tissues lining the pelvis.

Pelvic inflammatory disease (PID)

PID is an infection of the uterus, fallopian tubes or ovaries. often, it is caused by sexually transmitted bacteria. The bacteria cause inflammation of the reproductive organs and abdominal pain.

Cervical stenosis

Cervical stenosis is a rare condition in which the cervical opening is narrow and it slows menstrual flow. As a result, pressure may increase inside the uterus, causing pain.

Uterine fibroids cause painful menstruation

Fibroids are noncancerous tumors that can exert pressure on the uterus or cause painful menstruation and irregular periods.

Premenstrual syndrome (PMS)

This is a group of symptoms resulting from hormonal changes in the body that occur 1 to 2 weeks before menstruation starts. These hormonal changes go away after a woman begins to bleed.

Adenomyosis

Adenomyosis is a rare condition in which the lining of the uterus grows into the uterine muscular wall. This can be painful because it causes pressure and inflammation.

What are the home remedies for painful menstruation?

Home care treatments are effective in relieving dysmenorrhea.

You can do the following at home:

• Exercise regularly
• Eat nutritious, light meals
• Take a warm bath
• Practice yoga and other relaxation techniques
• Take anti-inflammatory medications such as ibuprofen some days before onset of your menstrual period
• Massage your abdomen
• Use a heating pad on your back or pelvic area
• Lie down with your knees bent
• Raise your legs with your bent knees
• Reduce intake of caffeine, salt, alcohol and sugar to prevent bloating
• Take magnesium rich foods
• Take omega-3 fatty acids supplements
• Take vitamins B-1, B-6, E and calcium supplements

When is the time to call a doctor for painful menstruation?

It may be time to talk to your doctor if your menstrual pain is affecting your ability to successfully perform basic tasks. Speak with your doctor about your symptoms.

Additionally, let your doctor know if you experience any of the following:

• Passage of blood clots per vagina
• Three or more painful menstrual periods
• Persistent pain after IUD insertion
• Pelvic pain in the absence of menstruation
• Diarrhea and nausea associated with abdominal pain

If you have sudden pelvic pain or cramping, it could be a sign of infection. Note that an untreated infection can cause scar tissue which can damage the pelvic organs and cause infertility.

Seek prompt medical attention if you have symptoms of an infection such as:

• Fever
• Foul-smelling vaginal discharge
• Sudden abdominal pain
• Severe pelvic pain

How is painful menstruation diagnosed?

In diagnosing dysmenorrhea, your doctor will first take your medical history to check for underlying causes of painful menstruation.

Your doctor will also perform a physical examination such as a pelvic exam. A pelvic exam checks for signs of infection and any abnormalities in your reproductive system.

Your doctor may perform imaging tests if s/he thinks an underlying disorder is the cause of your symptoms.

Your doctor may request these imaging tests:

• Ultrasound: a handheld device that is moved over the skin, and uses sound waves to see inside the body.
• MRI: a detailed, noninvasive imaging test that uses radio waves and magnetic fields to see inside the body.
• CT scan: a detailed, noninvasive imaging test that uses X-rays to see inside the body.

Also, your doctor may order a laparoscopy, depending on the imaging test results. Laparoscopy is a test in which a doctor makes small abdominal incisions and inserts a fiber-optic tube with a camera at the end to visualize abdominal cavity.

How is painful menstruation treated medically?

Some medical treatment options are available if home remedies do not relieve your menstrual pain. However, medical treatment depends on the underlying cause of your pain and the severity.

For example, your doctor may prescribe antibiotics if PID or sexually transmitted infections are responsible for your pain. The antibiotics aim to clear the infections.

Also, your doctor may prescribe the following medications:

Antidepressants

Your doctor may prescribe antidepressants to help lessen some of the mood swings associated with premenstrual syndrome.

Pain relievers

Your doctor may prescribe pain relievers which include over-the-counter drugs like naproxen sodium or ibuprofen.

Nonsteriodal anti-inflammatory drugs (NSAIDS)

You can find NSAIDS such as Tylenol as over-the-counter drugs. Similarly, your doctor can recommend prescription-strength NSAIDS.

Hormonal birth control

Additionally, your doctor may recommend that you try hormonal birth control. Hormonal birth control involves the use of patch, pill, injection, implant or vaginal ring.

Birth control hormones prevent ovulation which in turn control menstrual pain.

Surgery may be an option for painful menstruation

For painful menstruation caused by uterine fibroids or endometriosis, surgery is an option if other treatment options have failed.

The surgery takes out uterine fibroids, cysts or any endometriosis implants. Also, surgical removal of the uterus (hysterectomy) may be done if all other treatments failed and pain is severe.

Finally, hysterectomy is usually only used in women who do no plan on having children. Similarly, it may be an option in women who are at the end of their childbearing years.

Was this post helpful? Share your thoughts in the comments section.