Dysmenorrhea
Hey, Bestie. We should talk about period cramps. In short, they totally suck. For some, they don’t exist, but for others they can be completely debilitating and impact an individual’s ability to accomplish regular daily activities. So, why is period pain so bad for some and not for others? What are the causes behind period pain and how can symptoms be managed? Let’s chat about it!
What is period pain?
Period pain, cramps, or painful menstruation all fall under one umbrella term, dysmenorrhea. Dysmenorrhea is pain associated with menstruation. Because it is linked to menstruation, dysmenorrhea is cyclical pain, meaning it occurs in cycles. As you move through your menstrual cycle, you will have increases and decreases in your symptoms. Typically, period cramps start one to three days before you start menstruating and they are usually gone before you finish menstruating (1). Period pain or cramps may feel like a continuous, dull ache in your lower abdomen or low back, or they may present as sharp pain. The pain may even be present in your thighs (1).
As we discussed last time, the uterus grows an inner, endometrial lining throughout your cycle in order to prepare for potential implantation of a fertilized egg. If pregnancy does not occur, the uterus expels that endometrial lining in order to start the next cycle fresh. The expulsion of the uterine lining is menstruation. During your period, the uterus contracts in order to expel its inner lining. Remember, the middle layer of the uterus is a muscle, so the uterus is able to contract just like the other muscles in your body. This contraction can be painful.
What causes dysmenorrhea?
When we talk about dysmenorrhea, we break it up into two categories: primary and secondary. Primary dysmenorrhea is recurrent pain during menstruation with no underlying pathology (2). Secondary dysmenorrhea is pain during menstruation relating to an underlying disease or disorder (2).
Some of the common causes for secondary dysmenorrhea include endometriosis, fibroids, and pelvic inflammatory disease (PID). Endometriosis is the presence of endometrial tissue (uterine lining) outside of the uterus. Painful menstruation is one of the chief complaints of folks with endometriosis. Fibroids are non-cancerous growths that form in and around the uterus. During menstruation when the uterus is contracting, the presence of fibroids can place extra pressure on the surrounding tissues, causing pain or discomfort (3). Finally, PID is the infection of the reproductive organs, including the uterus, fallopian tubes, or the ovaries. It is most often a result of sexually transmitted infections (STIs) such as chlamydia or gonorrhea. The infection leads to inflammation and this can cause pain (4).
How can dysmenorrhea be managed?
Primary dysmenorrhea can be managed with a variety of methods. Hormonal birth control such as oral contraceptive pills have been shown to reduce pain in folks with primary dysmenorrhea (5). Other treatment options include the use of a hot pack over the area of discomfort (abdomen or back), the use of over-the-counter pain-relief medications, or the use of a transcutaneous electrical nerve stimulation (TENS) unit over the site of discomfort. Sometimes light exercise and/or stretching can help symptoms, as well. Talk with your pelvic health provider to find out which pain management methods might work best for you and to discuss whether you could have an underlying pelvic pathology. Finally, certain dietary supplements may help relieve symptoms. Studies have shown that ingesting zinc capsules improves symptoms of primary dysmenorrhea (6). Other studies have suggested many more potential dietary supplements for improvement in period pain, such as chamomile, cinnamon, and fish oil, but the research is still lacking at this point (7).
Secondary dysmenorrhea may be managed with the same tools, with the addition of treatments directly addressing the underlying condition(s). For example, in those with endometriosis, one treatment might be surgical removal of the endometriosis lesions and this could result in decreased pain during menstruation. PID is treated with antibiotics to remove the infection, and this should result in decreased inflammation and pain during menstruation. Fibroids can be removed surgically and their removal may improve symptoms of period pain. None of these methods of treatment are perfect, as there may still be residual scarring or inflammation present.
If you are suffering from intense menstrual cramping and recurrent pain during menstruation, talk with your physician, pelvic health therapist, or dietitian. Ideally, your providers will be able to collaborate on a treatment plan that is a perfect fit for you. Oh, and a bar of chocolate surely can’t hurt, either.
XOXO,
Your Pelvic Bestie
References:
1. “Menstrual Cramps.” Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938. Accessed 26 Nov. 2023.
2. Dysmenorrhea - StatPearls - NCBI Bookshelf, www.ncbi.nlm.nih.gov/books/NBK560834/. Accessed 26 Nov. 2023.
3. “4 Ways Uterine Fibroids Can Affect Your Period.” 4 Ways Uterine Fibroids Can Affect Your Period: Gynecology and Obstetrics Medical Group: OB/GYNs, www.gynobmedgroup.com/blog/4-ways-uterine-fibroids-can-affect-your-period. Accessed 26 Nov. 2023.
4. “4 Ways Uterine Fibroids Can Affect Your Period.” 4 Ways Uterine Fibroids Can Affect Your Period: Gynecology and Obstetrics Medical Group: OB/GYNs, www.gynobmedgroup.com/blog/4-ways-uterine-fibroids-can-affect-your-period. Accessed 26 Nov. 2023.
5. Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009 Oct 7;2009(4):CD002120. doi: 10.1002/14651858.CD002120.pub3. Update in: Cochrane Database Syst Rev. 2023 Jul 31;7
6. Teimoori B, Ghasemi M, Hoseini ZS, Razavi M. The Efficacy of Zinc Administration in the Treatment of Primary Dysmenorrhea. Oman Med J. 2016 Mar;31(2):107-11.
7. Pattanittum P, Kunyanone N, Brown J, Sangkomkamhang US, Barnes J, Seyfoddin V, Marjoribanks J. Dietary supplements for dysmenorrhoea. Cochrane Database Syst Rev. 2016 Mar 22;3(3):CD002124.
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
