PAINFUL PERIODS: OVERVIEW, CAUSES & TREATMENT

What is Dysmenorrhea

Dysmenorrhea is a medical term used to describe painful menstrual periods. Period pains cause significant interference with the quality of life and is one of the leading causes of temporary school absenteeism amongst adolescent girls and young women. It is quite common and is estimated to occur in three out of four women of the reproductive age group with about 15 to 30 percent experiencing of severe dysmenorrhea. There are two types of dysmenorrhea; primary dysmenorrhea and secondary dysmenorrhea.

Your Nyalife Women’s Health gynecologist will discuss your concerns and address your needs.

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What is the Cause of Primary Dysmenorrhea?

Theories have been advanced as to the cause with the biochemical theory taking lead. It results from uterine muscle contractions during menstrual flow which is caused by some chemicals known as prostaglandins, which are released from the endometrial lining that is shed during menstruation. The amount of prostaglandins has been found to be higher amongst women who experience period pains compered to their counter parts who do not. Another cause is Vasopressin, Vasopressin increase uterine contractions and also cause ischemic pain since it leads to constriction of the uterine vessels resulting in ischemia (no blood and oxygen supply).

What are the Risk Factors for Primary Dysmenorrhea?

• Age- younger women are at increased risk of primary dysmenorrhea while generally women in the reproductive age group are at increased risk.
• Nulliparity
• Heavy and prolonged menstrual flow
• Smoking
• Depression and Anxiety
• Lack of Social Support
• Family history of dysmenorrhea
• Attempts at weight loss

How Long do the Period Pains Last?

Primary Dysmenorrhea is associated with menstrual flow and usually starts with the onset of the menses and last two to three days. The period pain is usually more on the first day and tends to decrease as the amount of menstrual fluid decreases over time.

What are the Signs and Symptoms of Primary Dysmenorrhea?

Lower abdominal pains or uterine cramping that is intermittent or dull and constant. The pain may spread to the back and thighs. Period pains may be associated with other symptoms like loose stool motions, nausea, vomiting, headache, dizziness and low moods.

Diagnosis

Your doctor will most likely do an abdominal examination which may not reveal any organic abnormality

A pelvic examination may be performed to rule out secondary dysmenorrhea. For adolescent girls this may be done incase you are sexually active to rule out infections.

A pelvic ultrasound, diagnostic laparoscopy may be requested in refractory cases to diagnose secondary causes of period pains

What is the Treatment for Painful Periods?

Medical treatment

Non-Steroidal Anti-inflammatory Drugs (NSAIDs) like Ibuprofen, Diclofenac, mefenamic acid and others in the same class are highly effective and usually advised to be taken 1 or 2 days before onset of menses and for about two days upon onset of menses. They stop prostaglandin formation which is the cause of the period pains

Other Medical Treatments

Your gynecologist may prescribe among other medications; combined oral contraceptive pills, Depo Shot and contraceptive vaginal ring

Alternative Therapies

• Heat Therapy

Application of local heated patch or use of heated water in a bottle and applied to the lower abdomen may ease the pain

• Supplements

Vitamin E supplements, thiamine, fish oil supplements containing omega 3 polyunsaturated fatty acids have been shown to offer benefit

• Acupuncture and Acupressure
• Herbal Remedies

Tiki-Shakuyaku-San, a Japanese herb, is the only one that has been scientifically studied and found to be of benefit

• Transcutaneous Nerve Stimulation (TENS)

What is the Cause of Secondary Dysmenorrhea?

Different pathologies within the pelvis and without have been known to cause lower abdominal pains or uterine cramping.

1. Endometriosis is the leading cause of secondary dysmenorrhea. It is a chronic multisystemic inflammatory condition emanating from presence of ectopic endometrial tissues outside of the endometrium. Other symptoms other than the period pains include pain during micturition (dysuria), pain when passing stool (dyschezia), pain associated with sexual intercourse (deep dyspareunia), chronic pelvic pain and infertility
2. Adenomyosis refers to presence of endometrial tissue within the uterine muscle layer. It leads to symmetric enlargement of the uterus and period pains.
3. Pelvic Inflammatory Disease. Infections spreading to the female upper genital tract organs are sexually transmitted and ascend to the endometrium causing endometritis, fallopian tubes causing salpingitis, ovaries leading to oophoritis and pelvic inflammation and even tubo-ovarian masses and abscesses. If this is left untreated the sequelae may include infertility, increased risk of ectopic pregnancies and chronic pelvic pain.
4. Uterine fibroids and Uterine Polyps. These are benign, non-cancerous growths that may arise from the uterine muscle or endometrium. They may be associated with painful menstrual cramps and other symptoms like prolonged, heavy and intermenstrual bleeding.
5. Contraceptive Intrauterine Devices (IUDs) may result in painful menstrual cramps in some of its users
6. Ashermann Syndrome in which case there are adhesions in the uterine cavity may cause period pains and reduced menstrual bleeding.

What are the Risk Factors for Secondary Dysmenorrhea?

The risk factors depend on the pathology involved but generally it is more common in older women of the reproductive age group.

How Long do the Period Pains Last?

With Secondary Dysmenorrhea, the lower abdominal pain or uterine cramping may not only be experienced during menses but can occur before onset of menses and exist beyond the duration of the menstrual flow.

What are the Symptoms of Secondary Dysmenorrhea?

Lower abdominal pains or uterine cramping, dyspareunia, heavy and prolonged menses, intermenstrual bleeding , abnormal pelvic discharge, infertility, back pain, abdominal swelling may be additional symptoms depending on the pelvic pathology in question. Other symptoms such as dizziness may come about in heavy menstruation.

How is Secondary Dysmenorrhea Diagnosis made?

Your gynecologist will make a diagnosis based on your history, physical findings and investigations when necessary.

An abdominal examination by your doctor may reveal an abdominal mass arising from the pelvis.

A pelvic examination is normally performed and may reveal abnormal pelvic discharge, pelvic mass and nodules to rule out secondary dysmenorrhea.  infections.

A pelvic ultrasound can diagnose endometriomas

Laparoscopy or laparotomy with biopsy is used to diagnose endometriosis.

What is the Treatment for Painful Periods?

Definitive treatment requires treatment of the underlying condition which results in the period pain. This may require administration of antibiotics, hormonal IUDs and surgery such as hysterectomy

Supportive treatment can relieve the symptoms such pain

Talk to your gynecologist for treatment of the pelvic pathology.

Your Nyalife Women’s Health gynecologist will discuss your concerns and address your needs.

Make An Appointment with Your Nyalife Women’s Health Gynecologist Today.