Menstruation happens as the uterus sheds its lining once a month. During such periods, experiencing cramps, pain and any form of discomfort is essentially normal. But when the pain becomes worse that it restricts you to go to school or work, then it requires attention.

A painful menstruation is clinically known as dysmenorrhea, which can be classified as primary or secondary.

Primary dysmenorrhea is manifested in women who experience the pain before and during the course of menstruation. If you used to have normal periods earlier in life but become painful later on, it might be what is known as secondary dysmenorrhea. Underlying conditions that affect the uterus and pelvic organs like uterine fibroids and endometriosis can cause secondary dysmenorrhea.

What causes painful menstrual periods?

Generally, it is not easy to identify the main cause of this condition. In fact, some women are simply at a risk of suffering from painful menstrual periods especially when they are:

below 20 years old
have a family history of painful periods
smoker
have heavy menstrual bleeding during monthly periods
have irregular menstrual periods
never had a baby
reached puberty before 11 years of age

Prostaglandin is a hormone naturally found inside the body responsible for causing muscle contractions inside the uterus in order to release the lining. Such contractions cause pain and inflammation and prostaglandin levels increase just before the start of menstruation.

Painful menstrual periods can also be the result of any underlying clinical conditions like:

Premenstrual syndrome (PMS) – is a condition caused by hormonal changes in the woman’s body which happens 1 – 2 weeks before the start of menstruation. Typically, symptoms subside and go away as menstrual bleeding starts.

Endometriosis – is a significantly painful clinical condition wherein cells from the uterus lining abnormally grow in other areas of the female reproductive system, usually on the ovaries, fallopian tubes, or in the tissue around the pelvis.

Fibroids inside the uterus – forms when fibroids, which are noncancerous tumors, put some tension on the uterus and sometimes may cause abnormal pain and menstruation and pain.

Pelvic inflammatory disease (PID) – is an infection that affects the uterus, ovaries, and fallopian tubes that are often caused by sexually transmitted microorganisms, causing pain and inflammation of the reproductive organs.

Adenomyosis – is a rare gynecological condition characterized by growth of uterine lining in the uterus’ muscular wall. This results in pain, inflammation, pressure and sometimes longer and heavier periods.

Cervical stenosis – is a rare condition of the woman’s cervix where the cervix becomes so narrow or small and thereby antagonizes menstrual flow. The pain increases due to the pressure happening inside the uterus.

Home treatment

There are home remedies proven to be helpful in alleviating the agony of monthly menstrual periods. These include:

Placing a heating pad over your back or pelvic area
Massaging abdomen
Taking a bath with warm water
Exercising regularly
Eating light but nutritious meals
Meditating and doing yoga exercises
Taking anti-inflammatory medicines like ibuprofen few days before your period
Taking vitamins and supplements such as vitamin B-6, calcium, vitamin B-1, magnesium, vitamin E, and omega-3 fatty acids
Raising the legs or lying with bended knees
Reducing salt, caffeine, sugar and alcohol intake to avoid bloating

When to call your doctor

When the menstrual pain is already interfering with your basic tasks at a given time of the month, it is highly indicative that to consult a gynecologist.

If you experience at least one of the following, it is the high time to discuss them to your doctor about:

painful menstrual periods for the last three months
persistent pain following IUD placement
passing blood clot
pain in the pelvic area when not menstruating
cramping with nausea or diarrhea

Unexpected pelvic pain and cramping could indicate an infection and if left untreated, it may lead to scar tissue that affects the pelvic organs and further increase the risk of infertility.

If you experience any of the symptoms of infection, a medical attention is needed right away:

fever
sudden pain (especially if you might be pregnant)
excruciating pelvic pain
unpleasant vaginal discharge

Diagnosis

In order to detect the underlying cause of painful menstruation, the physician will assess your medical history and have a look at your reproductive system by conducting a pelvic exam to check for any form of abnormalities. The doctor may also like to check for any sign of infection.

If the doctor suspects if an underlying condition directly results from your symptoms, he/she may order the necessary imaging tests like:

ultrasound
MRI
CT scan

Depending on the imaging test results, your doctor may also perform a laparoscopy. This is an imaging procedure wherein the doctor makes minimal incision in the abdomen and inserts a camera-guided fiber-optic tube to see the inside of the abdominal cavity.

Medical treatment

If home treatments are not effective enough in relieving menstrual pain, there are also medical interventions.

The treatment options will depend on the pain severity and its underlying cause. If the pain results from PID or any type of sexually transmitted infections (STIs), the doctor will prescribe some antibiotics to cure the infection.

Such medications could be:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These groups of medicines can be purchased over the counter but some of them have prescription-strength as well.

Other pain relievers. They are also classified as over-the-counter medicines such as acetaminophen (Tylenol) but also come with stronger prescription drugs.

Antidepressants. These prescription drugs may also help in avoiding some episodes of mood swings related to PMS.

On the other hand, your doctor may offer you to use hormonal birth control. These groups of interventions include patch, pill, vaginal ring, injection, IUD and implant. The reason for having this option is because hormones block ovulation and thereby control menstrual cramps.

Surgery cures endometriosis and removes uterine fibroids. This option is best if other treatments have not been successful. This surgical intervention also removes implants or cysts.

In some cases, a hysterectomy or the removal of the uterus is a good option if all the other treatments haven’t worked well and did not alleviate the pain. Patients who underwent hysterectomy will no longer be able to conceive anymore. Thus, it must be noted that this procedure will not work if the patient is still planning to have a baby or is at her childbearing years.