Many girls and women have problems like abdominal cramps and pain during their menstrual period. The medical term for painful periods is “dysmenorrhea.” Although menstruation is a normal part of a woman's life, severe period pain need not be. Women do not have to simply put up with it – menstrual pain can usually be treated effectively. If you have very painful periods or the pain keeps getting worse over time, it can be a good idea to see a doctor.
Every month the lining of a woman’s womb builds up and is then shed again at the end of the menstrual cycle, when she has her period – unless she is pregnant. To shed the lining during the monthly period, the muscles of the womb tighten (contract) and relax in an irregular rhythm. This helps the tissue lining the womb to detach and flow out of the body, together with blood, through the neck of the womb (cervix) and the vagina.
The muscle contractions are sometimes not noticeable or only cause mild discomfort, but are also sometimes felt as painful cramps. Period pain might only affect the lower abdomen, or it might be felt in the back or legs too. It can cause nausea, vomiting or diarrhea in some women, as well as headaches or general discomfort. Women who have heavier periods often have more intense pain too.Menstrual cycle
Causes and risk factors
Doctors distinguish between two types of period pain, called primary and secondary dysmenorrhea. If period pain is caused by the womb muscle contractions alone it is called primary dysmenorrhea. It is not known why the contractions are painful in some women and not in others, but it is likely to involve the production of too many prostaglandins or a particular sensitivity to them.
Prostaglandins are hormone-like chemical messengers. They influence the perception of pain and cause the muscles in the womb to tighten, helping to shed the lining of the womb.
Period pain that is caused by something other than the muscle contractions is called secondary dysmenorrhea. Benign (non-cancerous) growths in the womb, such as fibroids or polyps, are often responsible for secondary dysmenorrhea. Endometriosis might also cause severe period pain. In endometriosis, the kind of tissue that lines the womb (endometrium) grows elsewhere in the abdomen too. Sometimes contraceptive coils (IUDs: intrauterine devices) used for birth control can also cause secondary dysmenorrhea.
Prevalence and outlook
Period pain is very common: most girls and women have pain of varying intensity at some point during their period. In 10 out of 100 women the pain is so bad that they are unable to carry out their usual daily activities on one to three days every month.
Moderate to severe primary dysmenorrhea is more common in women under the age of 20. The pain usually gets better or even goes away completely within a few years of their first period. Many women have milder period pain after the birth of their first child.
Secondary dysmenorrhea often first arises after a young woman has already been menstruating for several years. Here, women may also have pain at times of the month other than during menstruation.
Women and girls get a lot of (sometimes contradictory) advice from doctors and other women. But the only things that have been scientifically proven to relieve period pain so far are birth control pills and painkillers such as ibuprofen or naproxen.
Painkillers known as non-steroidal anti-inflammatory drugs (NSAIDs) lower the production of prostaglandin, thereby relieving period pain. Birth control pills prevent ovulation. This reduces the amount of prostaglandin produced, the lining of the womb doesn't become as thick as usual, and the period is lighter.
Although NSAIDs are usually well tolerated, they sometimes have side effects, especially stomach-related problems. The birth control pill can have side effects too, such as headaches and nausea. They increase the risk of thrombosis as well. Some herbal medications and dietary supplements are also known to have side effects.
Many women try out the following approaches too:
- Applying heat by using hot water bottles or heating pads, taking a warm bath or going to the sauna
- Special diets and dietary supplements
- Herbal products and herbal teas for medicinal use, homeopathic medicines
- Procedures which target pain stimulus, such as acupuncture, acupressure or TENS (transcutaneous electrical nerve stimulation)
Sometimes the pain is so bad that psychological treatments (such as pain management through behavioral therapy, or biofeedback) are considered.
Sometimes friends, relatives, colleagues and even doctors do not take period pain seriously. But severe pain that affects a woman’s everyday activities on several days a month, maybe even preventing her from working, is not something that has to be put up with because it is “natural.” Advice like this can make it difficult to feel comfortable about withdrawing from activities to get some rest, and might stop women from seeking professional help or treatment.
It may be possible to find ways to deal with the “painful” days so they are less of a problem. For example, many women try to take things a bit easier on those days. Some find that relaxation techniques, breathing exercises, yoga or tai chi help them feel more relaxed and reduce stress. Getting a lot of exercise also helps relieve period pain in some women.
Women who are often unable to go to work because of bad pain and cramps may face problems at work, as well as feeling guilty and ashamed. Having a partner, relatives or friends who are understanding and supportive can make an important difference.
Latthe PM, Champaneria R. Dysmenorrhoea. BMJ Clin Evid 2014.
Marjoribanks J, Ayeleke RO, Farquhar C, Proctor M. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev 2015; (7): CD001751.
Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM. Behavioural interventions for primary and secondary dysmenorrhoea. Cochrane Database Syst Rev 2007; (3): CD002248.
Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev 2009; (4): CD002120.
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