Painful Menstrual Periods

(Dysmenorrhea; Menstrual Cramps)

Definition

Painful menstrual periods, also called dysmenorrhea, may include pain in the pelvis, abdomen, back and legs; abdominal cramps; headache; and fatigue. Most women have painful periods at some time in their lives. In some women, the pain is severe enough to interfere with normal activities.
There are two types of dysmenorrhea:
  • Primary dysmenorrhea—painful regular menstrual cycles caused by uterine muscle contractions
  • Secondary dysmenorrhea—painful periods due to an underlying condition, such as endometriosis , which is a condition involving the lining of the uterus, or infection
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Causes

Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.
Secondary dysmenorrhea can be caused by:

Risk Factors

Painful menstrual periods are more common in women under age 30 years. Other factors that may increase your risk of having painful menstrual periods include:
  • Low body weight, especially during adolescence
  • Smoking
  • Early onset of menstruation—younger than 12 years old
  • Longer menstrual cycles
  • Heavy bleeding during periods
  • Never having delivered a baby
  • Psychological disorders, such as depression or anxiety
You are also at risk if you have a related condition, such as endometriosis or ovarian cysts.

Symptoms

The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing or dull and aching. It is most typically located in the lower abdomen and may spread to the low back or thighs. Other symptoms may include:
  • Nausea
  • Vomiting
  • Diarrhea
  • Headache
  • Irritability

When Should I Call My Doctor?

Call your doctor if you have:
  • Severe or unusual cramps
  • Cramps that last for more than a few days
  • Signs of infection, such as fever or chills
  • Cramps with heavy menstrual bleeding
  • Abdominal or pelvic tenderness
  • Vaginal discharge other than menstrual bleeding
Also, call you doctor if you are having vaginal bleeding or pain and are unsure if it is related to menstruation.

Diagnosis

Your doctor will ask detailed questions about your symptoms and medical history. A pelvic exam will be done.
Your internal structures may need to be viewed. This can be done with:

Treatment

Primary dysmenorrhea is usually treated with medications and lifestyle changes.
The treatment of secondary dysmenorrhea varies depending on the underlying condition.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs), available over-the-counter, are usually the first-line treatment for menstrual pain. Examples of these medications include ibuprofen and naproxen.
Birth control pills may be prescribed in some cases.

Other Treatments

  • Heat therapy—Heating pads, warm baths, or continuous low-level heat patches may help to ease discomfort.
  • Exercising regularly may help to reduce menstrual cramps.
  • Find out if alternative treatments are a good option for you, for example:
    • Some herbs and supplements may be helpful, such as vitamin B1, magnesium, and Chinese herbal medicine. Talk to your doctor before taking any herbs and supplements. They may interact with your other medications and conditions.
    • Acupuncture may also help to reduce pain.

Prevention

To help reduce your chance of painful menstrual periods, take the following steps:
  • Exercise regularly.
  • If you smoke, talk to your doctor about how you can quit.
  • Drink only moderate amounts of caffeine and alcohol.

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org

FamilyDoctor.org—American Academy of Family Physicians http://familydoctor.org

CANADIAN RESOURCES

Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health Matters http://www.womenshealthmatters.ca

References

Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999;60:489-496.

Dysmenorrhea. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/dysmenorrhea/hic%5Fdysmenorrhea.aspx. Updated October 5, 2012. Accessed September 5, 2013.

Dysmenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 3, 2013. Accessed September 5, 2013.

Menstrual cycle problems. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/menstrual-cycle-problems.html. Accessed September 5, 2013.

Dysmenorrhea: symptoms. American Academy of Family Physicians' FamilyDoctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/dysmenorrhea/symptoms.html. Updated January 2011. Accessed January 9, 2012.

French L. Dysmenorrhea. Am Fam Physician. 2005;71:285-291. Available at: http://www.aafp.org/afp/2005/0115/p285.html. Accessed September 5, 2013.

Pelvic inflammatory disease (PID): CDC fact sheet. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/pid/stdfact-pid.htm. Updated September 28, 2011. Accessed September 5, 2013.

9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008;198:166.e1-8.

4/15/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014;89(5):341-346.

6/18/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review. J Physiother. 2014;60(1):13-21.

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