Period pain is not always an indication of any underlying disorder, either with the reproductive organs or related systems. It may affect 50% of menstruating women with or without any other associated disturbance of the menstrual cycle, ovulation or menstruation. However, when it does occur, it can in some cases be debilitating and severely impair a woman’s ability to function on a daily basis. For the large majority of women suffering with period pain, it is mild, lasts 1 to 2 days at most and can often be managed without medication. At most, these women may need to temporarily use pain relieving medication. Some women, however, experience severe period pain and more rigorous treatment is necessary in these cases.
Period pain can present with other symptoms that may or may not be a consequence of the pain itself. In these cases, the appropriate treatment may be necessary for symptomatic relief. However, persistent pain that tends to last longer than 3 days, which may become progressively worse over time and be associated with other symptoms particularly menstrual disturbances should always be investigated further. This type of period pain may be known as secondary dysmenorrhea and may be the consequence of some underlying disease particularly gynecological disorders. Most women, however, have primary dysmenorrhea which is period pain that occurs without any underlying pelvic pathology.
Signs and Symptoms of Period Pain
Period pain, also known as dysmenorrhea, is a symptom and not a disease or condition. In most cases the pain is felt in the lower abdomen or back in the first 1 or 2 days of menstruation. It may arise just before menstruation but rarely persists beyond 3 days. The pain is typically described as a menstrual cramp, cramping pain or aching pain which may be accompanied by a pulling sensation in the upper thigh. It may extend to the hips and higher up in the abdomen.
Period pain needs to be differentiated from mid-cycle or ovulation pain which occurs around day 14 of a 28 day cycle. This pain, also known as Mittelschmerz, occurs when the ruptured follicle that releases an egg cell into the fallopian tube bleeds and the blood leaks into the abdominal cavity and irritates the peritoneal lining. It is more often felt as a one-sided pain and is sometimes more prominent in conditions like polycystic ovarian syndrome.
The pain may be accompanied by :
- Loose stool
- Loss of appetite
Treatment of Period Pain
Various diagnostic investigations may be necessary to differentiate primary from secondary dysmenorrhea. The latter is more commonly seen with conditions like endometriosis, chronic pelvic inflammatory disease and uterine fibroids. Other disorders that may be contributing factors include uterine polyps, polycystic ovary syndrome, adhesions, tumors or even an ectopic pregnancy. A thorough medical history and pelvic examination are the first steps in identifying underlying causes of period pain. Laboratory studies such as a complete blood count (CBC), urinalysis, Pap smear and pregnancy test may precede and imaging studies. Diagnostic imaging techniques may include an ultrasound, CT scan, MRI, hysteroscopy or laparoscopy.
Pain Relief Without Medication
Most women experience mild pain and may not require or wish to use pain relieving medication immediately. There are several measures to manage the pain and this may include :
- Heat therapy. Placing a hot water bottle or heat pad on the abdomen is effective for many women. Sometimes a hot shower or bath may also be helpful.
- Light massage on the lower abdomen or back.
- Eat regular small meals.
- Drink plenty of liquids. Warm beverages may be soothing.
- Rest as much as possible. Lie down with legs elevated or on side with knees bent.
- Avoid caffeinated or alcoholic beverages.
- Stretching exercise and yoga may be helpful but avoid strenuous techniques.
- Meditation and deep breathing may assist with pain management.
- Vitamin B1, B6, calcium and magnesium supplements may be helpful.
The focus on pain relief should also be to prevent it as far as possible. Certain risk factors for painful periods have been identified and some of these are modifiable meaning that it can be treated or prevented. Women with suffering with painful periods should therefore consider the following measures where applicable :
- Lose weight.
- Exercise regularly.
- Stop smoking.
- Avoid alcohol consumption before and during menstruation. Practice moderation during other times.
Treating Pain with Medication
Non-steroid anti-inflammatory drugs (NSAIDs) are more commonly used as it is easy to acquire over-the-counter (OTC) and often effective for pain relief. NSAIDs block the action of prostaglandins which as discussed under causes of painful periods appears to be the main mediator of period pain. Analgesics may also be necessary for pain relief.
- Ibuprofen is one of the more commonly used NSAIDs that is available without a prescription.
- Acetaminophen (paracetamol) is also commonly used for its analgesic properties.
- Meclofenamate is a prescription NSAID that may be used in more severe cases.
- Codeine is a stronger analgesic that may be necessary for more severe pain and will require a prescription.
Oral contraceptives (birth control pills) may help with period pain, mid-cycle pain and regulating the menstrual cycle if necessary. Antidepressants may be considered and can help with certain cases period pain. Antibiotics may be necessary for pelvic inflammatory disease.
Surgery is indicated for women with endometriosis and uterine fibroids. Rarely, surgical remove of the uterus (hysterectomy) may be considered for period pain but this is a last resort.