Period pain. All that you need to know.
Period pain, also known as dysmenorrhea, is one of the most common problems to affect women1. It begins for most women during adolescence, usually within four to five years of the first menstruation1. Period pain can significantly impact your life, resulting in a restriction of daily activities, poor quality of sleep, and negative effects on mood, causing anxiety and depression2.
Normal Menstrual Cycle
Your menstrual cycle is the period between two menstruation phases; or from the first day of the last menstruation to the first day of the next menstruation3. The menstrual cycle can vary in cycle length from 26 to 35 days4.
Menstruation is one part of your cycle when the lining of the uterus (known as the endometrium) is shed3. With each monthly cycle, the endometrium prepares itself to nourish a fetus3. In 80% of ovulatory women, menstrual bleeding occurs over 3 to 6 days (but it can vary between 2 and 12 days), with the heaviest flow on Day 2. The amount of blood loss averages 33.2 ml (10–84 ml)4.
Is it usual to have period pain?
Period pain is a global problem, and it is experienced by 45-93% of women of reproductive age2. For some women, the discomfort is merely annoying5. For others, period pain can be severe enough to interfere with everyday activities for a few days every month5.
The characteristics of period pain include5:
- Intense throbbing or cramping pain in your lower abdomen 5
- Pain usually starts 1 to 3 days before your period, peaks 24 hours after the onset of your period and subsides in 2 to 3 days5
- Dull, continuous ache5
- Pain can radiate to lower back and thighs5
Other symptoms accompanying period pain include nausea, loose stools, headache and dizziness5.
What are the causes of period pain?
Period pain can be classified as2,5:
- primary – menstrual pain without organic disease2,5
- secondary – menstrual pain associated with pelvic pathology2,5
Primary period pain is associated with a high level of prostaglandins2,5. During your period, the uterus contracts to help expel its lining5. Prostaglandins, which are involved in pain and inflammation, trigger uterine muscle contractions5. Higher levels of prostaglandins are connected with more severe period pain5.
Secondary period pain can occur due to:2,5
- Endometriosis. The presence of tissue similar to the lining of the womb being present outside the uterus, most commonly on ovaries, fallopian tubes or the tissue lining your pelvis2,5.
- Uterine fibroids. These are noncancerous growths in the wall of the uterus that can cause pain5.
- Adenomyosis. The tissue that lines your uterus begins to grow into the myometrium which are the muscular walls of the uterus2,5.
- Pelvic inflammatory disease. This infection of the female reproductive organs is usually caused by sexually transmitted bacteria5.
How to relieve period pain?
For management of primary period pain, your physician could prescribe you2:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) which block prostaglandin production2. Common NSAIDs are very effective in relieving period pain2
- Oral contraceptives that suppress ovulation and cause no endometrial proliferation2. These may be helpful against heavy and painful periods and irregular bleeding2
- Intrauterine device (IUD). The intrauterine device can reduce dysmenorrhea by as much as 50 percent1.
Self-care approaches to pain relief include1,6:
- Getting enough sleep and rest6
- Exercise regularly. Medical studies show that exercise reduces menstrual symptoms, including pain1,6
- Use heat. Applying heat to the lower abdomen with a heating pad, hot water bottle, or self-heating patch can significantly reduce pain, often as effectively as treatment with an NSAID1,6
- You can try dietary supplements, such as vitamin E, omega-3 fatty acids, vitamin B-1 (thiamin), vitamin B-6 and magnesium6
- Reduce stress6
When should you see your physician?
We recommend you to see your physician when5:
- Menstrual pain disrupts your life every month5
- Your symptoms progressively worsen5
- You just started having severe menstrual pain after age 255
- Patient education: Painful menstrual periods (dysmenorrhea) (Beyond the Basics) https://www.uptodate.com/contents/painful-menstrual-periods-dysmenorrhea-beyond-the-basics Last access 15.06.2022
- Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Res. 2017;6:1645. Published 2017 Sep 5.
- Menstrual Cycle: An Overview https://www.hopkinsmedicine.org/health/wellness-and-prevention/menstrual-cycle-an-overview Last access 15.06.2022
- Mihm M, Gangooly S, Muttukrishna S. The normal menstrual cycle in women. Anim Reprod Sci. 2011 Apr;124(3-4):229-36.
- Menstrual cramps https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938 Last access 15.06.2022
- Menstrual cramps https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944 Last access 15.06.2022