Painful Menstrual Periods: Causes & Treatment Options

Menstruation is a completely natural process of the uterus shedding its lining which occurs once a month. Although part of the natural healthy monthly cycle, it can be uncomfortable. When a woman is on her period, she may be experiencing cramps, pain and other forms of discomfort. These are normal symptoms of menstruation and for most women, they are manageable. 

But when a woman endures excessive pain which renders her incapable of performing her regular daily tasks, it may be time to seek urgent medical attention. Having painful menstruation is clinically known as dysmenorrhea, which can be classified as primary or secondary.

Primary dysmenorrhea is manifested in women who experience intense pain prior to and during the course of menstruation. 

But if you used to have normal periods earlier in life that became painful at some point, 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.

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Frequently Asked Questions

What causes painful menstrual periods? 

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

  • Under 20
  • Reached puberty at a young age (at age 10 or younger)
  • Genetically predisposed to have painful periods (family history)
  • Heavy flow
  • Irregular periods
  • Smokers
  • Not having given birth

So where does the pain come from? 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 can be followed by pain and inflammation and prostaglandin levels increase just before the start of menstruation.

Alternatively, painful periods can caused by underlying clinical conditions like:

  • Premenstrual syndrome (PMS): Hormones are the cause of this condition or, more specifically, hormonal changes in the woman’s body. The change takes place a week or two before a woman starts menstruating. Typically, symptoms subside and go away as menstrual bleeding starts.
  • Adenomyosis: This rare gynecological condition is characterized by overgrowth of uterine lining in the uterus’ muscular wall. This results in pain, inflammation, pressure and may also cause longer and heavier periods.
  • Cervical stenosis: 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.
  • Endometriosis: Endometriosis is a seriously painful clinical condition caused by abnormal cell growh from the uterus lining in other areas of the female reproductive system, usually  the ovaries, fallopian tubes, or in the tissue of the pelvic region.
  • Pelvic inflammatory disease (PID): This infection that affects the uterus, ovaries, and fallopian tubes that are often caused by sexually contracted microorganisms, causing pain and inflamed reproductive organs.
  • Fibroids inside the uterus: Noncancerous tumors or fibroids put some tension on the uterus and sometimes may cause abnormal pain and menstruation and pain.

What are my home treatment options? 

There are home remedies proven to be effective at alleviating the agony of menstrual periods. These include:

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

When should I contact my doctor? 

When the menstrual pain is preventing your from perofrming your normal day-to-day tasks and activities during that time of the month, it is absolutely necessary to consult a gynecologist.

If you experience at least one of the symptoms below, it is high time to discuss the matter with your doctor:

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

Unexpected pelvic pain and cramping could indicate an infection and if left untreated, it may lead to scar tissue. Scar tissue not only affects the pelvic organs but may also further increase the risk of infertility.

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

  • fever
  • abrupt pain (this is an alarming symptom, especially if you might be pregnant)
  • excruciating pelvic pain
  • unpleasant vaginal discharge

Want to Know More About Painful Menstruation?

In order to detect the real cause of painful menstruation, the physician will need to assess your medical and possibly family history and check the health of 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, you may need to undergo laparoscopy. This is an imaging procedure wherein the doctor makes a minimal incision in the abdomen and inserts a camera-guided fiber-optic tube to see the inside of the abdominal cavity.

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

The treatment options will depend on the pain severity and its underlying cause. If the pain results from PID or another sexually transmitted infection, 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 recommend you start taking hormonal birth control. Options include:

  • Patch
  • Pill
  • Injection
  • IUD
  • Vaginal ring
  • Implant. 

Any of these options will regulate hormones to block ovulation and keep menstrual cramps under control. 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 invasive procedure of removing the whole uterus is a reliable option if all the other treatments failed at alleviating pain. Patients who undergo hysterectomy will no longer be able to conceive. For obvious reasons, hysterectomy is recommended as a last resort and it is not an optimal solution for patients at childbearing years or planning to have a baby.