Painful Periods (Dysmenorrhea)

Dysmenorrhea is defined as severe, painful cramps during menstruation.

The signs and symptoms of dysmenorrhea include cramping and sometimes sharp pains in the lower abdomen, lower back and thighs. The pain starts at onset of menses and may last for hours to days. For some, the pain may begin a week or more prior to the onset of menses and continue for a few days after cessation of flow. Some women will also experience occasional nausea and vomiting, diarrhea, lack of energy, irritability, and depression. The painful contractions of the muscular wall of the uterus are believed to be due to substances called Prostaglandins. Women with dysmenorrhea produce and excrete more Prostaglandins than those who don’t suffer from painful periods. Infections of the pelvis, endometriosis, adenomyosis (benign growth of the endometrium), fibroids, as well as use of an IUD (Intrauterine device) may also be contributors to painful periods. The risk of painful periods increases with caffeine and nicotine use. Obesity and lack of exercise have also been linked to dysmenorrhea.

Most of the symptoms can be controlled with treatment and your doctor may recommend taking oral contraceptives to prevent ovulation. Often the symptoms will improve with age and after childbirth.

Initial treatment goals include relieving the pain. This requires that the cause of the pain be identified. A pelvic exam, patient history and ultrasound may be recommended. Further invasive procedures such as a laparoscopy, laparotomy, or dilation and curettage (D&C) may also be needed. Use of a heating pad or hot water bottle has also proven to be effective at relieving pain. Reducing consumption of caffeine containing beverages and adding a Vitamin B or Vitamin E supplement may also be helpful.

For minor discomfort, use non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen or naproxen. Oral contraceptives, which prohibit ovulation will help reduce pain as well and in severe cases, hormones (e.g., gonadotropin-releasing hormone [Gn-RH]) can stop ovary function and relieve pain.