Dysmenorrhea (painful periods)

Period pain or dysmenorrhea is a condition of painful menstrual periods. Menstrual cramps or pain is felt in the abdominal areas and can occur before the menstrual cycle begins and can continue for 2 to 3 days.

Primary dysmenorrhea is the common painful condition in women with no abnormalities in pelvic region. Women may experience severe pain before or at the onset of menstrual periods and the pain persists for 2–3 days. Primary dysmenorrhea is caused by the elevated levels of hormone prostaglandin produced by the tissues lining the uterus (womb). Prostaglandin triggers the uterine muscles to contract and push the uterus lining (endometrium) out of the body through vagina. Women who have high level of prostaglandin will experience intense pain and contractions.

Secondary dysmenorrhea is the painful condition that may be caused because of other gynaecological problems. This kind of pain begins early in menstrual cycle and lasts longer than primary dysmenorrhea. Conditions that may cause secondary dysmenorrhea include endometriosis, fibroids, infection, ovarian cysts, narrow cervix, abnormal pregnancy, and intrauterine device for birth control.

Some of the commonly observed symptoms are back pain, leg pain, nausea, vomiting, diarrhoea, headache, irritability, weakness, and fainting. Your doctor will perform a pelvic examination to identify if there are any other problems associated with menstrual cramps. Blood tests and cervical cultures will confirm if there is any sign of infection. Other diagnostic tests may be required which include MRI scan and ultrasound scan.

If the menstrual cramps are because of the underlying medical conditions, then treating the underlying medical conditions will help to relieve pain. The conservative approach includes nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and contraceptive pills which decrease the production of prostaglandins by preventing ovulation. However, these medicines are taken before the menstruation begins.

NSAIDs are contraindicated if you have a history of kidney and stomach problems. The other home remedies such as a heating pad to the pelvic area, regular exercises, massage to the back and abdomen, low-fat diet, and intake of calcium and thiamine tablets may help to treat period pain.

Surgery is very rarely conducted for patients with dysmenorrhea. It is done only if the other conservative treatments are not successful. Some of the procedures carried out are

  • Endometrial ablation– In this procedure, the superficial tissue layer lining the uterus is destroyed.  The extra tissue is destroyed by several ablation techniques such as laser beam, freezing, or heating. It is recommended in patients who have heavy uterine bleeding.
  • Endometrial resection– It is the procedure of removal of the endometrium by surgical method. It is done in patients who have heavy menstrual bleeding and who do not have uterine problems such as polyps or cancer. Surgical removal is not advisable for women who want to have children, as it removes part of the uterus.
  • Hysterectomy– It is the surgical removal of entire uterus. It is recommended if you have fibroids, uterine prolapse, cancer in the uterus, and vaginal bleeding. This procedure will stop periods and this procedure is not recommended in women who want to have children.