MENSTRUAL PAIN: Period Pain (Dysmenorrhoea): Period Pain (Dysmenorrhoea): Dysmenorrhoea is the medical term for painful periods. It is common for periods to be painful for teenagers and young adults. Periods tend to become less painful as you get older. An anti-inflammatory painkiller often eases the pain. In most cases, the cause of the pain during periods is not clear. Sometimes, usually in women in their 30s or 40s, a problem in the pelvis causes the pain.

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Dysmenorrhea, also known as painful periods, or menstrual cramps, is pain during menstruation.[1][2] Its usual onset occurs around the time that menstruation begins.[1] Symptoms typically last less than three days.[1] The pain is usually in the pelvis or lower abdomen.[1] Other symptoms may include back pain, diarrhea, or nausea.[1]

In young women painful periods often occur without an underlying problem.[3] In older women it is more often due to an underlying issues such as uterine fibroids, adenomyosis, or endometriosis.[3] It is more common among those with heavy periods, irregular periods, whose periods started before twelve years of age, or who have a low body weight.[1] A pelvic exam in those who are sexually active and ultrasound may be useful to help in diagnosis.[1] Conditions that should be ruled out include ectopic pregnancy, pelvic inflammatory disease, interstitial cystitis, and chronic pelvic pain.[1]

Dysmenorrhea occurs less often in those who exercise regularly and those who have children early in life.[1] Treatment may include the use of a heating pad.[3] Medications that may help include NSAIDs such as ibuprofen, hormonal birth control, and the IUD with progestogen.[1][3] Taking vitamin B or magnesium may help.[2] Evidence for yoga, acupuncture, and massage is insufficient.[1] Surgery may be useful if certain underlying problems are present.[2]

Estimates of the percentage of women of reproductive age affected varying from 20 to 90%.[1] It is the most common menstrual disorder.[2] Typically it starts within a year of the first menstrual period.[1] When there is no underlying cause often the pain improves with age or following having a child.[2]

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Who has painful periods?
Most women have some pain during periods. The pain is often mild but, in about 1 in 10 women, the pain is severe enough to affect day-to-day activities. The pain can be so severe that they are unable to go to school or work. Doctors may call period pain ‘dysmenorrhoea’. Period pain is one type of pelvic pain.

Primary dysmenorrhoea is the most common type of painful periods. This occurs where there is no underlying problem of the womb (uterus) or pelvis. It often occurs in teenagers and in women in their 20s.

Secondary dysmenorrhoea is pain caused by a problem of the womb or pelvis. This is less common and is more likely to occur in women in their 30s and 40s.

Period Pain Q&A
What’s the best way to get rid of period pain? What causes period pain? How much period pain is too much? All your questions answered.

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What are the causes of painful periods?
The cause is often not clear (this is called primary dysmenorrhoea). The womb (uterus) is normal. It is thought that normal body chemicals (called prostaglandins) build up in the lining of the womb. Prostaglandins help the womb to contract and remove the lining of the womb during a period. In women with period pain there seems to be a build-up of too much prostaglandin, or the womb may be extra sensitive to the prostaglandins. This may cause the womb to contract too hard. This reduces the blood supply to the womb and leads to pain.

Secondary dysmenorrhoea
A problem of the womb or pelvis sometimes causes painful periods. For example:

Endometriosis.
Fibroids.
Infection of the womb and Fallopian tubes (pelvic inflammatory disease).

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What are the symptoms of period pain?
The main symptom is crampy pain in your lower tummy (abdomen). Often, the first few periods that you have are painless. Period pains may only begin 6-12 months after you have started your periods. The pain:

May spread to your lower back, or to the top of your legs.
Usually starts as the bleeding starts, but it may start up to a day before.
Usually lasts 12-24 hours but lasts 2-3 days in some cases.
Can vary with each period. Some periods are worse than others.
Tends to become less severe as you get older, or after having a baby.
In some women, other symptoms occur as well as pain – for example:

Headaches.
Tiredness.
Faintness.
Breast tenderness.
Feeling sick (nausea).
Bloating.
Diarrhoea.
Feeling emotional or tearful.
Note: the following are not symptoms of primary dysmenorrhoea:

High temperature (fever).
Vaginal discharge.
Sudden severe abdominal pain.
Pain when you have sex.
Vaginal bleeding between periods.
Vaginal bleeding after having sex.
You should see your doctor if any of these symptoms develop.

Secondary dysmenorrhoea
Again, the main symptom is crampy lower tummy pain during your periods. With secondary dysmenorrhoea, your periods tend to become more painful after several years of ‘normal’ periods (that is, periods with normal, mild, period pains).

The following may indicate secondary dysmenorrhoea:

If you have a change in your usual pattern of pain. For example, if your periods become more painful than they used to be, or the pain lasts longer than it used to. In some women with secondary dysmenorrhoea the pain starts several days before the period begins, and lasts all the way through the period. (This is uncommon with primary dysmenorrhoea.)
If you have other symptoms – for example:
Irregular periods.
Bleeding between periods.
Pains between periods.
The bleeding becomes heavier than previously.
Vaginal discharge.
Pain during sex.
Pain in your back passage (rectum).
You should see your doctor if you develop any of these problems.

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Signs and symptoms[edit]
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen or pelvis.[1] It is also commonly felt in the right or left side of the abdomen. It may radiate to the thighs and lower back.[1]

Symptoms often co-occurring with menstrual pain include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, and fatigue. Symptoms of dysmenorrhea often begin immediately after ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. The use of certain types of birth control pills can prevent the symptoms of dysmenorrhea because they stop ovulation from occurring.

Causes[edit]
Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition.

The most common cause of secondary dysmenorrhea is endometriosis, which can be visually confirmed by laparoscopy in approximately 70% of adolescents with dysmenorrhea.[4]

Other causes of secondary dysmenorrhea include leiomyoma,[5] adenomyosis,[6] ovarian cysts, and pelvic congestion.[7]

Unequal leg length might hypothetically be one of the contributors, as it may contribute to a tilted pelvis, which may cause lower back pain,[8] which in turn may be mistaken for menstrual pain, as women with lower back pain experience increased pain during their periods.

Other skeletal abnormalities, such as scoliosis (sometimes caused by spina bifida) might be possible contributors as well.

Mechanism[edit]
During a woman’s menstrual cycle, the endometrium thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up uterine tissue is not needed and thus shed.

Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents.[9] Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These substances are thought to be a major factor in primary dysmenorrhea.[10] When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or “cramps” experienced during menstruation.

Compared

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