DYSMENORRHEA (PAINFUL PERIODS)
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 call period pain ‘dysmenorrhoea’.
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 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.
What causes the pain of primary dysmenorrhoea?
The cause is not clear. 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.
What are the symptoms of primary dysmenorrhoea?
The main symptom is crampy pain in the abdomen. Often, the first few periods are painless. Period pains may only begin 6-12 months after starting periods. The pain:
- May spread to the lower back, or to the top of one’s 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 with age, or after having a baby.
In some women, other symptoms occur as well as pain – for example:
- Breast tenderness.
- Feeling sick (nausea).
- Feeling emotional or tearful.
How is primary dysmenorrhoea diagnosed?
In many cases (particularly in teenagers) the symptoms are so typical that it can be confidently diagnosed by a doctor based on the symptoms.
What are the treatment options for primary dysmenorrhoea?
Most women with painful periods have mild pain that they can treat themselves at home. However, if the pain becomes more severe and is interfering with usual activities, a doctor should be consulted.
There are a number of treatments that may help if with primary dysmenorrhoea:
- Warmth: a hot water bottle against the lower abdomen, or hot bath can be soothing. The pain often does not last long, and this may be all that is needed.
- Non-steroidal anti-inflammatory painkillers: these can greatly ease the pain in about 7 out of 10 cases. They work by blocking the effect of the prostaglandin chemicals that are thought to cause the pain. Also, non-steroidal anti-inflammatory painkillers usually reduce the amount of bleeding. Some tips when using an anti-inflammatory include the following:
- The first dose should be taken as soon as the pain begins, or as soon as the bleeding starts, whichever comes first. Some doctors advise to start taking the tablets the day before the period is due. This may prevent the pain from building up.
- The tablets should be taken regularly, for 2-3 days each period, rather than ‘now and then’ when pain builds up.
- If the pains are not eased, one may check if the dose being taken is the maximum allowed. An increase in dose may be all that is needed.
- Some people cannot take non-steroidal anti-inflammatory painkillers. For example, people with a stomach ulcer, and some people with asthma.
- Side-effects are uncommon if a non-steroidal anti-inflammatory painkiller is taken for just a few days at a time, during each period. The leaflet that comes with the tablets should contain a full list of possible side-effects and cautions.
- Paracetamol: this is an alternative painkiller that can be tried if non-steroidal anti-inflammatory painkillers cannot be taken.
- Combined hormonal contraceptive (CHC) in the form of ‘the pill’, the patch or the ring: one of these is an option if contraception is also needed. Heavy periods are much less likely if one takes CHC. They can also be used to have fewer periods in a year.
- The intrauterine system (IUS): a special intrauterine contraceptive called the IUS is an option if you also need long-term contraception. The IUS slowly releases a hormone that ‘thins’ the lining of the womb and reduces the amount of pain and bleeding during periods
- Alternative medicine treatments: there is not enough evidence so far to support the use of other treatments for painful periods. For example, herbal and dietary supplements, acupuncture, exercise and spinal manipulation. Some small studies have shown that some of these treatments may help but, overall, the effectiveness of these treatments is not clear. More studies are needed to help decide if these treatments are helpful or not for painful periods.
- Secondary dysmenorrhoea – period pain due to an underlying cause
What causes secondary dysmenorrhoea?
A problem of the womb (uterus) or pelvis sometimes causes painful periods. For example: endometriosis, fibroids, or infection of the womb and Fallopian tubes (pelvic inflammatory disease).
What are the symptoms of secondary dysmenorrhoea?
Again, the main symptom is crampy abdominal pain during periods. With secondary dysmenorrhoea, 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 there ia a change in the usual pattern of pain. For example, if 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 there are other symptoms – for example:
A doctor should be consulted if any of these problems develop.
How is secondary dysmenorrhoea diagnosed?
A doctor will usually examine a patient if they suspect secondary dysmenorrhoea. This may involve an internal examination to check the womb and pelvis as well as an examination of the abdomen. The idea is to look for possible causes of the painful periods, such as fibroids in the womb. The doctor may also take some samples (swabs) during the examination to look for any signs of infection.
Other investigations that are carried out depend on the likely underlying problem. They may include:
- An ultrasound scan of the womb and pelvis.
- Using a telescope to examine the inside of the womb (a hysteroscopy).
- Using a telescope to examine the internal organs of your pelvis (a laparoscopy).
What are the treatment options for secondary dysmenorrhoea?
Secondary dysmenorrhoea is treated according to the underlying cause.