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Painful menstrual periods

Menstruation - painful; Dysmenorrhea; Periods - painful; Cramps - menstrual; Menstrual cramps

 

Painful menstrual periods are periods in which a woman has crampy lower abdominal pain, which can be sharp or aching and come and go. Back pain may also be present.

Some pain during your period is normal, but a large amount of pain is not. The medical term for painful menstrual periods is dysmenorrhea.

Considerations

 

Many women have painful periods. Sometimes, the pain makes it hard to do normal household, job, or school-related activities for a few days during each menstrual cycle. Painful menstruation is the leading cause of lost time from school and work among women in their teens and 20s.

 

Causes

 

Painful menstrual periods fall into two groups, depending on the cause:

  • Primary dysmenorrhea
  • Secondary dysmenorrhea

Primary dysmenorrhea is menstrual pain that occurs around the time that menstrual periods first begin in otherwise healthy young women. In most cases, this pain is not related to a specific problem with the uterus or other pelvic organs. Increased activity of the hormone prostaglandin, which is produced in the uterus, is thought to play a role in this condition.

Secondary dysmenorrhea is menstrual pain that develops later in women who have had normal periods. It is often related to problems in the uterus or other pelvic organs, such as:

  • Endometriosis
  • Fibroids
  • Intrauterine device (IUD) made of copper
  • Pelvic inflammatory disease
  • Premenstrual syndrome (PMS)
  • Sexually transmitted infection
  • Stress and anxiety

 

Home Care

 

The following steps may help you to avoid prescription medicines:

  • Apply a heating pad to your lower belly area, below your belly button. Never fall asleep with the heating pad on.
  • Do light circular massage with your fingertips around your lower belly area.
  • Drink warm beverages.
  • Eat light but frequent meals.
  • Keep your legs raised while lying down, or lie on your side with your knees bent.
  • Practice relaxation techniques such as meditation or yoga.
  • Try over-the-counter anti-inflammatory medicine, such as ibuprofen. Start taking it the day before your period is expected to start, and continue taking it regularly for the first few days of your period.
  • Try vitamin B6, calcium, and magnesium supplements, especially if your pain is from PMS.
  • Take warm showers or baths.
  • Walk or exercise regularly, including pelvic rocking exercises.
  • Lose weight if you are overweight. Get regular, aerobic exercise.

If these self-care measures do not work, your health care provider may offer you treatment such as:

  • Birth control pills
  • Mirena IUD
  • Prescription anti-inflammatory medicines
  • Prescription pain relievers (including narcotics, for brief periods)
  • Antidepressants
  • Antibiotics

 

When to Contact a Medical Professional

 

Call your provider right away if you have:

  • Increased or foul-smelling vaginal discharge
  • Fever and pelvic pain
  • Sudden or severe pain, especially if your period is more than 1 week late and you have been sexually active.

Also call if:

  • Treatments do not relieve your pain after 3 months.
  • You have pain and had an IUD placed more than 3 months ago.
  • You pass blood clots or have other symptoms with the pain.
  • Your pain occurs at times other than menstruation, begins more than 5 days before your period, or continues after your period is over.

 

What to Expect at Your Office Visit

 

Your provider will examine you and ask questions about your medical history and symptoms.

Tests and procedures that may be done include:

  • Complete blood count (CBC)
  • Cultures to rule out sexually transmitted infections
  • Laparoscopy
  • Ultrasound

Treatment depends on what is causing your pain.

 

 

References

Alvero R. Dysmenorrhea. In: Ferri FF, ed. Ferri's Clinical Advisor 2017. Philadelphia, PA: Elsevier; 2017:395-395.

Lentz GM. Primary and secondary dysmenorrhea, premenstrual syndrome, and premenstrual dysphoric disorder: etiology, diagnosis, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 36.

Pattanittum P, Kunyanone N, Brown J, et al. Dietary supplements for dysmenorrhea. Cochrane Database Syst Rev. 2016;3:CD002124. PMID: 27000311. www.ncbi.nlm.nih.gov/pubmed/27000311.

The American College of Obstetricians and Gynecologists. Dysmenorrhea: painful periods. FAQ046, January 2015. www.acog.org/Patients/FAQs/Dysmenorrhea-Painful-Periods. Accessed June 29, 2016.

 
  • Female reproductive anatomy

    Female reproductive anatomy - illustration

    External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

    Female reproductive anatomy

    illustration

  • Relieving PMS

    Relieving PMS - illustration

    The cause of premenstrual syndrome is not known but severe symptoms have been shown to be responsive to lifestyle changes. Getting exercise several times a week, eating a balanced diet, getting adequate sleep, and reducing or eliminating caffeine and alcohol are some of the changes most often recommended.

    Relieving PMS

    illustration

  • Uterus

    Uterus - illustration

    The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

    Uterus

    illustration

    • Female reproductive anatomy

      Female reproductive anatomy - illustration

      External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.

      Female reproductive anatomy

      illustration

    • Relieving PMS

      Relieving PMS - illustration

      The cause of premenstrual syndrome is not known but severe symptoms have been shown to be responsive to lifestyle changes. Getting exercise several times a week, eating a balanced diet, getting adequate sleep, and reducing or eliminating caffeine and alcohol are some of the changes most often recommended.

      Relieving PMS

      illustration

    • Uterus

      Uterus - illustration

      The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.

      Uterus

      illustration

    A Closer Look

     

      Self Care

       

      Tests for Painful menstrual periods

       

         

        Review Date: 5/21/2016

        Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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