Pain during menstruation is familiar to most: estimates suggest dysmenorrhea occurs in 50–90% of adolescents and women of reproductive age. This does not mean that any pain should be endured: some cases have a clear mechanism, while others are a signal of a disease that can be treated. Below—calmly about where the line of normal lies, how primary and secondary dysmenorrhea differ, and when pain becomes a reason for examination.
What is dysmenorrhea
Dysmenorrhea is pain during menstruation. It usually begins around the same time as the period, although it may start in the middle of the cycle. The pain usually radiates to the lower abdomen or pelvis, extends to the lower back and thighs, and lasts less than three days.
Along with pain, nausea and vomiting, diarrhea, headache, dizziness, and fatigue are common. In 5–15% of women with dysmenorrhea, symptoms are pronounced enough to interfere with daily activities.
Where the pain comes from
During menstruation, the uterus contracts—this is a normal part of the cycle. Painful cramps may result from an excess of prostaglandins produced by the uterus: they cause muscles to tense and relax, and this is felt as pain. Prostaglandins also explain some of the gastrointestinal symptoms.
Primary and secondary dysmenorrhea
Primary dysmenorrhea occurs without an underlying disease. It usually begins in adolescence soon after the first menstruation, and the pain often decreases with age or after childbirth.
Secondary dysmenorrhea has a specific cause—a condition affecting the uterus or other reproductive organs. Causes include endometriosis (found in about 70% of adolescents with secondary dysmenorrhea), uterine fibroids, adenomyosis, ovarian cysts, and pelvic inflammatory disease. An intrauterine device can also cause pain, especially in the first 3–6 months after insertion.
The guideline is simple: if pain occurs between periods, lasts longer than the first few days, or is not adequately relieved, it may indicate secondary dysmenorrhea.
Endometriosis and fibroids as causes
Endometriosis is when cells similar to those lining the uterus grow in other parts of the body: most often in the pelvic area—in the ovaries, fallopian tubes, peritoneum, sometimes in the bladder, bowel, or even the chest. Symptoms appear when endometriosis areas break down and bleed, but the blood cannot leave the body.
Signs of endometriosis that a doctor evaluates separately: pain during and after sex, pain during bowel movements or urination, pronounced fatigue, difficulty conceiving.
Fibroids are growths in and around the uterus; this is one cause of secondary dysmenorrhea.
How it is diagnosed
Diagnosing endometriosis often takes a long time: symptoms resemble adenomyosis, fibroids, pelvic inflammatory disease, and irritable bowel syndrome. The doctor will ask about symptoms and whether endometriosis occurred in close relatives, may perform a physical examination, including an internal vaginal exam, and refer for blood tests.
Next, ultrasound (abdominal or vaginal), MRI, and laparoscopy are possible—a procedure with a camera through a small incision in the abdomen that can confirm endometriosis. A gynecological examination and ultrasound can be useful for diagnosing dysmenorrhea.
When pain is not normal
It is normal to feel pain or discomfort before or during your period. What is not normal and should be discussed with a doctor:
- Periods have become more painful, heavier, or irregular.
- Pain prevents you from doing usual activities.
- Pain during sex, urination, or defecation.
- Bleeding between periods.
- Changes in the frequency of urination or defecation, bloating, loss of appetite, or weight loss without trying.
With these signs, see a family doctor; they may refer you to a gynecologist if the pain does not go away or if a fibroid or another condition is suspected. If the pain is severe or stronger than usual and painkillers have not helped, see a doctor the same day.
Call 103 or 112 if abdominal pain is accompanied by loss of consciousness, confusion, inability to speak, or other signs of a life-threatening condition.
This material is for reference: it does not replace consultation with a doctor who sees your specific situation.
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This content is for reference and does not replace a doctor's consultation. Medical disclaimer