Period pain or menstrual pain is a very common condition and is experienced by more than 80% of the females at some part of their life. In majority of the cases, it is not severe enough to hamper daily functioning or require medical treatment and is treatable by home remedies. In others, it may affect your social or professional life and may need medical treatment. Let us understand the definition, causes, symptoms, treatment and prevention of this condition, one by one.
Table of Contents
What is period pain?
Period pain is the pain felt in your lower abdomen that starts just before or during your menstrual cycles. Its is also called menstrual pain or menstrual cramps or dysmenorrhea. Although these terms are usually used synonymously, Dysmenorrhea refers to menstrual pain that impairs normal day to day functioning, causing absenteeism from work or study and needs medical treatment.
What are the symptoms of period pain?
Period pain may vary widely in it’s presentation, character, feel and severity. However, in most females:
- It generally begins with menarche (when you have your first periods), although in many females, it may begin 6 to12 months after menarche.
- It usually starts along the with the menstrual flow and lasts for 1-2 days. In others, it may start before or after the start of menstruation and last for less than a day or for the entire duration of menstruation.
- Most females describe the character of pain as:
- a cramping pain or
- a throbbing pain or
- a constant, dull pain or
- simply heaviness in the lower abdomen.
- In addition, some females have associated symptoms like:
- Gastrointestinal symptoms like nausea, vomiting, diarrhoea, loss of appetite
- Other pains like headache, backache or pain in thighs
- Anxiety or depression
- Sleeplessness (insomnia), ache flaring
- Lack of energy and easy fatigability
- Vasomotor symptoms like vertigo, cold sweats and even fainting.
What causes period pain?
Based on the cause, period pain is classified as:
- Primary dysmenorrhea (Spasmodic type): In this, there is no identifiable pelvic pathology to explain the symptoms. It is the more common of the two types.
- Secondary dysmenorrhea (Congestive type): In this, the symptoms are ascribed to an identifiable pelvic pathology. This is less common than primary dysmenorrhea.
Primary dysmenorrhea (Spasmodic type)
- As explained above, there is no pelvic pathology to account for the period pain.
- It is usually seen in young, adolescent girls, belonging to affluent society.
- It is more commonly seen with girls with early menarche. A greater association is observed with smoking, very high or very low body mass index (<20 or >30) and a family history of dysmenorrhea. It is seen to stop or reduce after pregnancy and vaginal delivery.
- It is described as a spasmodic, cramping pain in the lower abdomen. It begins along with the menstruation or a few hours before and lasts for few hours but rarely beyond 48 hours. Associated symptoms like nausea, vomiting, diarrhea, headache or backache may be present. Some females may feel easy fatigability, lack of energy, paleness or cold sweats.
- The pain is caused by uterine hyperactivity and dysrhythmic contractions leading to uterine muscle hypoxia. This uterine hyperactivity is believed to be caused by an increased production of prostaglandins in the body or a hyperactive response of the uterus to normal levels of prostaglandins, an increased level of vasopressin in the body or an overactivity of the sympathetic nervous system.
- Diagnosis is primarily based on history. Examination and ultrasound are generally normal.
- Most of the females respond to conservative measures and home remedies. Pain severe or incapacitating enough to need treatment, is seen in less than 20% females. For further details of treatment, see treatment of period pain below.
Secondary Dysmenorrhea (Congestive type)
- In contrast to primary dysmenorrhea, there is an underlying pelvic disease that is found to be the cause of the period pain.
- It is usually seen in older women, in their thirties, with no correlation to their social status.
- It is often described as a constant dull pain or heaviness in the lower abdomen or back. Unlike primary dysmenorrhea, there is no pain radiation or any other associated symptoms with the pain.
- Pain generally starts a few days before the periods and is relieved with the onset of menstruation.
- Pregnancy or delivery has no impact on increasing or decreasing the severity of pain.
- The pain is due to pelvic congestion caused by an increased blood supply to the pelvis, due to the pelvic pathology.
- Common conditions causing secondary dysmenorrhea are uterine fibroids, adenomyosis, endometriosis, chronic pelvic inflammatory disease (PID), pelvic infections etc.
- Diagnosis is based on history, supported by pelvic examination findings and ultrasound findings. In addition, some blood tests or urine test may also be needed for diagnosis.
- Sometimes, invasive surgical procedures like laparoscopy and hysteroscopy may need to be done, as a diagnostic measure to visualize the lesions or as a diagnostic-therapeutic measure for obtaining a sample or removing of the lesion.
- The primary aim of treatment here is identification and treatment of the causative pelvic pathology. However, all the treatment modalities used in primary dysmenorrhea can be used for symptomatic relief of pain, till the time the pelvic pathology is identified and treated. For further details of treatment, see treatment of period pain below.
Treatment of Period pain
Reassurance along with education and understanding about the period pain, goes a long way in allying the anxiety associated with the pain, especially in young girls. Other methods that can be used are:
Home remedies for painful periods
- Avoid stress: Practice Meditation and other relaxation techniques
- Improvement of general health: Take a good nutritious diet and maintaining hydration.
- Continue routine activities and sports: Moderate, regular physical activity is seen to be beneficial.
- Heat pads or warm water bottles or hot water bath: helps to soothe the pain.
- Multivitamins like B-complex vitamins and Vit C: help by improving vitality of the body.
- Omega-3 fatty acids and evening primrose oil: Omega-3 fatty acids help reduce pain and cramping by their anti-inflammatory action. Primrose oil helps to maintain hormonal balance and therefore reduce dysmenorrhea and breast pain during periods.
Alternate remedies for painful periods
- Physiotherapy
- Ayurvedic preparations from natural herbs, with pain relief properties
- Acupressure
- Acupuncture
- TENS: High frequency transcutaneous electrical nerve stimulation is a commonly used pain relief method in physiotherapy which offers good pain relief. It can help to avoid or reduce the need for pain killers (analgesics). It can be done by a trained physiotherapist at your home.
Medical management of painful periods
- Prostaglandin synthetase inhibitors: These drugs exhibit direct analgesic (pain relief) efficacy and also inhibit prostaglandin synthesis in the body, thereby preventing uterine hyperactivity caused by prostaglandin excess. For example, indomethacin, aspirin etc.
- NSAIDS (Nonsteroidal anti-inflammatory drugs): are a newer class of prostaglandin inhibitors with lesser side effects and improved efficacy. For example, ibuprofen (Advil), naproxen, mefenamic acid.
- Tablet Meftal spas is a popular drug containing mefenamic acid and an antispasmodic called dicyclomine hydrochloride and is found to be very effective in the relief of symptoms of period pain.
- Depending on the severity, these drugs can be used either on – as and when required basis or started before periods and continued for 3-4 days in severe cases.
- It is pertinent to mention that all prostaglandin synthetase inhibitors, including newer NSAIDS have side effects. So, although they may be available over the counter in some countries, they should be used under medical supervision. Some of the common side effects include gastritis, gastric ulcers, nausea, vomiting, blood thinning and easy bruising, high blood pressure, kidney problems, heart attacks and strokes etc.
- Oral Contraceptive pills: Combined estrogen and progesterone oral contraceptive pills, used for 3-6 cycles, reduce ovulation and reduces the prostaglandin production from uterine endometrium (inner lining of uterus). This decreases both the uterine blood flow and the period pain associated with it.
When to visit a doctor?
You should visit your doctor if:
- Your period pain is severe and impacting your daily activities like school, work or sports.
- Your period pain has worsened and increased in severity than before.
- Your period pain is associated with heavy bleeding, irregular bleeding, fever or other distressing symptoms like nausea, vomiting, diarrhea, depression, anxiety, easy fatigability etc.
Can I stop period period pain forever?
Yes, in certain cases, it’s possible to stop period pain forever. In others, it’s possible to reduce the severity and duration to period pain to more acceptable levels with certain lifestyle modifications.
- In secondary dysmenorrhea, since there is an pelvic pathology causing the symptoms, identifying and treating the cause, stops the period pain forever.
- In primary dysmenorrhea, pregnancy and vaginal birth have been observed to stop or reduce the severity of dysmenorrhea.
- Other factors which reduce the severity of dysmenorrhea are:
- Quitting smoking
- Taking good nutritious diet with lots of fruits, salads and green, leafy vegetables
- Avoiding foods rich in sugar, salt or fat
- Preferring vegetarian diets
- Doing regular, moderate physical exercise
- Avoiding stress and practicing relaxation techniques
Can sex reduce menstrual cramps?
We know that dysmenorrhea happens due to congestion of the uterus caused by increased blood flow towards it during the menstrual phase. Sexual intercourse further increases the blood flow to the uterus due to arousal. So technically this will increase dysmenorrhea.
But some may find sex to be a relieving activity during periods as it produces feel good hormones called as endorphins.
The actual answer to the question for a female lies in the cause of her dysmenorrhea and suitability of sexual intercourse to the person.
Carry home message
Dysmenorrhea is a common symptom and is usually caused by natural prostaglandins secreted in the body. So it is the result of normal processes going on in your body and do not need treatment, unless it is severe enough to hamper your day to day activities or caused by a pelvic pathology. Every female must have knowledge of period pains and should not hesitate to consult your doctor if needed. stay healthy!
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