Painful menstrual periods

Definition

Painful menstrual periods are periods in which a woman has crampy lower abdominal pain, sharp or aching pain that comes and goes, or possibly back pain.

Although some pain during your period is normal, excessive pain is not. The medical term for painful menstrual periods is dysmenorrhea.

Alternative Names

Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps

Considerations

Many women have painful periods. Sometimes, the pain makes it difficult to perform normal household, job, or school-related activities for a few days during each menstrual cycle. Painful menstruation is the leading cause of lost time from school and work among women in their teens and 20s.

Common Causes

Painful menstrual periods fall into two groups, depending on the cause:

• Primary dysmenorrhea
• Secondary dysmenorrhea

Primary dysmenorrhea is menstrual pain that occurs around the time that menstrual periods first begin in otherwise healthy young women. This pain is usually not related to a specific problem with the uterus or other pelvic organs. Increased activity of the hormone prostaglandin, which is produced in the uterus, is thought to play a role in this condition.

Secondary dysmenorrhea is menstrual pain that develops later in women who have had normal periods and is often related to problems in the uterus or other pelvic organs, such as:

• Endometriosis
• Fibroids
• Intrauterine device (IUD) made of copper
• Pelvic inflammatory disease
• Premenstrual syndrome (PMS)
• Sexually transmitted infection
• Stress and anxiety

Home Care

The following steps may allow you to avoid prescription medications:

• Apply a heating pad to your lower belly area, below your belly button. Never fall asleep with the heating pad on.
• Do light circular massage with your fingertips around your lower belly area.
• Drink warm beverages.
• Eat light but frequent meals.
• Follow a diet rich in complex carbohydrates such as whole grains, fruits, and vegetables, but low in salt, sugar, alcohol, and caffeine.
• Keep your legs raised while lying down, or lie on your side with your knees bent.
• Practice relaxation techniques such as meditation or yoga.
• Try over-the-counter anti-inflammatory medicine, such as ibuprofen. Start taking it the day before your period is expected to start, and continue taking it regularly for the first few days of your period.
• Try vitamin B6, calcium, and magnesium supplements, especially if your pain is from PMS.
• Take warm showers or baths.
• Walk or exercise regularly, including pelvic rocking exercises.
• Lose weight if you are overweight. Get regular, aerobic exercise.

If these self-care measures do not work, your doctor may prescribe medications such as:

• Antibiotics
• Antidepressants
• Birth control pills
• Prescription anti-inflammatory medicines
• Prescription pain relievers (including narcotics, for brief periods)

Call your health care provider if

Call your doctor right away if you have:

• Increased or foul-smelling vaginal discharge
• Fever and pelvic pain
• Sudden or severe pain, especially if your period is more than one week late and you have been sexually active.

Also call your doctor if:

• Treatments do not relieve your pain after 3 months.
• You have pain and had an IUD placed more than 3 months ago.
• You pass blood clots or have other symptoms with the pain.
• Your pain occurs at times other than menstruation, begins more than 5 days before your period, or continues after your period is over.

What to expect at your health care provider's office

Your doctor will examine you, paying close attention to your pelvis and abdomen, and ask questions about your medical history and current symptoms, such as:

• How old were you when your periods started?
• Have they always been painful? If not, when did the pain begin?
• When in your menstrual cycle do you experience the pain?
• Is the pain sharp, dull, intermittent, constant, aching, or cramping?
• Are you sexually active?
• Do you use birth control? What type?
• When was your last menstrual period?
• Was the flow of your last menstrual period a normal amount for you?
• Do your periods tend to be heavy or prolonged (lasting longer than 5 days)?
• Have you passed blood clots?
• Are your periods generally regular and predictable?
• Do you use tampons with menstruation?
• What have you done to try to relieve the discomfort? How effective was it?
• Does anything make the pain worse?
• Do you have any other symptoms?

Tests and procedures that may be done include:

• Complete blood count (CBC)
• Cultures to rule out sexually transmitted infections
• Laparoscopy
• Ultrasound

Treatment depends on what is causing your pain.

Your health care provider may prescribe birth control pills to relieve menstrual pain. If you don't need them for birth control, you can stop using the pills after 6 to 12 months. Many women continue to have symptom relief even after stopping the medication.

Your doctor may prescribe prescription pain medications. For pain caused by an IUD, your doctor may recommend:

• Waiting 1 year after it was placed. Painful periods go away in many women during this time.
• Removing the IUD and using other types of birth control.
• Changing to a different type of IUD that contains progesterone, which usually makes the periods lighter and less painful.

Surgery may be needed if other treatments do not relieve your pain. Surgery may be done to remove cysts, fibroids, scar tissue, or your uterus (hysterectomy).

Prevention

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References

French L. Dysmenorrhea. Am Fam Physician. 2005;71:285-291.

Harel Z. Dysmenorrhea in adolescents and young adults: etiology and management. J Pediatr Adolesc Gynecol. 2006;19:363-371.

Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 36.