Menstruation occurs when the uterus sheds its lining once a month. The lining passes through a small opening in the cervix and out through the vaginal canal.
Some pain, cramping, and discomfort during menstrual periods is normal. Excessive pain that causes you to miss work or school is not.
Painful menstruation is also called dysmenorrhea. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs in women who experience pain before and during menstruation. Women who have had normal periods that become painful later in life may have secondary dysmenorrhea. A condition affecting the uterus or other pelvic organs, such as endometriosis or uterine fibroids, can cause this.
What are the causes?
There may not be an identifiable cause of your painful menstrual periods. Some women are at a higher risk for having painful menstrual periods. These risks include:
Being under age 20
Having a family history of painful periods
Smoking
Having heavy bleeding with periods
Having irregular periods
Never having had a baby
Reaching puberty before age 11
A hormone called prostaglandin triggers muscle contractions in your uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.
Painful menstrual periods can also be the result of an underlying medical condition, such as:
premenstrual syndrome (PMS): a group of symptoms caused by hormonal changes in the body that occur 1 to 2 weeks before menstruation begins and goes away after a woman begins to bleed
endometriosis: a painful medical condition in which cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis
Fibroids in the uterus: noncancerous tumours that can put pressure on the uterus or cause abnormal menstruation and pain
Pelvic inflammatory disease (PID): an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that causes inflammation of the reproductive organs and pain
Adenomyosis: a rare condition in which the uterine lining grows into the muscular wall of the uterus and can be painful because it causes inflammation and pressure
Cervical stenosis: a rare condition in which the cervix is so small it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain
Home treatment
Home care treatments may be successful in relieving painful menstrual periods and can include:
Using a heating pad on your pelvic area or back
Massaging your abdomen
Taking a warm bath
Regular physical exercise
Eating light, nutritious meals
Practising relaxation techniques or yoga
Taking an anti-inflammatory medication such as ibuprofen several days before your expected period
Taking vitamin B-6, vitamin B-1, vitamin E, omega-3 fatty acids, calcium, and magnesium supplements, and reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating
Raising your legs or lying with your knees bent
When to call a doctor
If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to your gynaecologist. Talk to your doctor about your symptoms and if you experience any of the following:
Continuing pain after IUD placement
At least three painful menstrual periods
Passing blood clots
Cramping accompanied by diarrhoea and nausea
Pelvic pain when not menstruating
Sudden cramping or pelvic pain could be signs of infection. An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility. If you have symptoms of an infection, seek prompt medical attention. Symptoms include:
Fever
Severe pelvic pain
Sudden pain, especially if you may be pregnant
Foul-smelling vaginal discharge
Diagnosis
Your doctor will first take your medical history to check for the underlying causes of your painful menstrual periods. They will also perform a physical examination. This will include a pelvic exam to check for any abnormalities in your reproductive system and to look for signs of infection.
If your doctor thinks an underlying disorder is causing your symptoms they may perform imaging tests. These may include:
Ultrasound: a handheld device that sends out sound waves is moved over the skin to see inside your body
CT scan: a noninvasive detailed imaging test that uses X-rays to see inside your body
MRI: a noninvasive detailed imaging test that uses magnetic fields and radio waves to see inside your body
Depending on the results of your imaging tests, your doctor may order a laparoscopy. This is a test in which a doctor makes small incisions in the abdomen into which they insert a fibre-optic tube with a camera at the end to see inside your abdominal cavity.
Medical treatment
If home treatment does not relieve your menstrual pain, there are some medical treatment options. Treatment will depend on the severity and underlying cause of your pain. If PID or sexually transmitted infections (STIs) are causing your pain, your doctor will prescribe antibiotics to clear the infections.
Your doctor may also prescribe medications that include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): You can find these drugs, such as Tylenol, over the counter, or get prescription-strength NSAIDs from your doctor.
Pain relievers: These can include over-the-counter options like ibuprofen (Advil and Motrin IB) or naproxen sodium (Aleve).
Antidepressants: Antidepressants can help lessen some of the mood swings associated with PMS.
Your doctor may also suggest that you try hormonal birth control. Hormonal birth control is available as a pill, patch, vaginal ring, injection, or implant. Hormones prevent ovulation, which can control your menstrual cramps.
Surgery can treat endometriosis or uterine fibroids. This is an option if other treatment options haven’t been successful. The surgery removes any endometriosis implants, uterine fibroids, or cysts.
In rare cases, a hysterectomy (surgical removal of the uterus) is an option if other treatments haven’t worked and pain is severe. If you have a hysterectomy you will no longer be able to have children. This option is usually only used in women who aren’t planning on having children or who are at the end of their childbearing years.
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