What you need to know about period pain

The causes & treatments of painful periods

Period pain or menstrual cramps are a perfectly normal thing to experience during your monthly bleed. The pain signifies that your next menstrual cycle is beginning in a perfectly healthy way.

The cramps can range from a nagging, aching pain which only lasts a couple of days to debilitating, extreme pain that renders the sufferer unable to function in the normal way. The pain is possibly the most common form of pelvic pain and the cramps can be felt just before and during menstruation

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Types of painful periods

The correct medical name for painful periods is dysmenorrhoea and there are two types:

  • Primary dysmenorrhoea - this is period pain in a general sense in that it has only one reason for happening and that is menstruation. It may begin 6 - 12 months after the onset of menstruation. It will likely start each month as your period is about to start and last 1 - 2 days
  • Secondary dysmenorrhoea - period pain is classed as secondary dysmenorrhoea when there is an underlying medical condition such as fibroids or endometriosis. This pain can commence many years after menstruation begins, even as late as when you’re in your 30’s or 40’s. In addition, the pain may not restrict itself to when you are menstruating, getting worse as your period goes on or occurring between periods

It may be that if you experience painful periods that other symptoms are experienced. The main symptom in primary dysmenorrhea is cramping in the lower abdomen although it may radiate to your lower back or thigh, however,  other symptoms may also occur:

  • Tiredness
  • Nausea or vomiting
  • Diarrhoea
  • Headache
  • Bloating
  • Emotional symptoms

In the case of secondary dysmenorrhoea, there may also be other symptoms:

  • A feeling of heaviness in the lower abdomen
  • Heavy and/or irregular periods
  • Unusual discharge from the vagina
  • Painful sex with some bleeding afterwards

 

Causes of painful periods

Let us firstly consider primary dysmenorrhoea. During the menstrual period, the uterus contracts to expel its lining. This is shed as menstrual flow. These contractions are triggered by hormone-like substances called prostaglandins but these prostaglandins are involved in pain and inflammation so the more prostaglandins that are released, the more severe the pain. 

When we consider secondary dysmenorrhoea, the same causes as above will apply. However, there are also other factors which as there as a result of the underlying condition that will contribute to added pain

  • Endometriosis - cells that normally line the womb can grow in other areas of the abdomen such as the fallopian tubes and ovaries. When the uterine tissue sheds from these areas it can cause intense pain.
  • Fibroids -These are non-cancerous tumours that can grow in or around the womb and so increase the pain and heaviness of the menstruation. In addition to this, fibroids may also result in pelvic pressure, lower back pain, leg pain, constipation, frequent urination, difficulties emptying the bladder and periods that last more than a week.
  • Pelvic inflammatory disease - in this condition the uterus, fallopian tubes and ovaries become infected with bacteria. This is usually caused by sexually transmitted infection, for example, chlamydia and gonorrhoea although other infections that are not sexually transmitted can cause it; this causes the area to become inflamed which will add to the overall pain. Whilst pelvic pain is the most common symptom of PID, other symptoms may include painful intercourse, bleeding during or after sex, foul-smelling vaginal discharge, burning sensation when urinating, fever and spotting between periods.
  • Adenomyosis - the tissue that would normally line the uterus begins to grow within the muscular wall of the uterus which makes menstruation particularly painful.
  • Cervical stenosis - this is also known as a ‘closed cervix’.  This describes a situation when the cervix is either completely closed or is very narrow. A person can be born with this condition or develop it later but it interferes with the exit of menstrual blood from the body. It will make periods light or even non-existent and may also result in fertility problems.
  • In addition, using the intrauterine device (IUD) as a form of contraception has been known to cause more painful periods. The extra pain however may subside a few months after the IUD is fitted. 

 

Treatment for period pain

The treatment needed to relieve your painful periods will depend very much on the reason for what you are experiencing.

In the case of primary dysmenorrhea, it is more than likely that over the counter painkillers will be sufficient to ease your discomfort or alternatively there are some self-help techniques to try:

Use a hot water bottle or heat patch to ease your abdomen or back
A warm bath or shower may help you relax and so help the pain
Gentle massage to the abdomen or back is well worth a try.

A trans electrical nerve stimulation (TENS) machine may help. This sends mild electrical signals to the skin covering the area you are feeling pain.  It is believed that this interrupts the pain signals travelling to your brain

In the case of secondary dysmenorrhea, however, you will need to consult with your GP in order that the cause of the dysmenorrhea can be confirmed and so the correct form of treatment given.

 

Medication

Non-steroidal anti-inflammatory drugs are most commonly prescribed for severe period pain. These drugs ease pain by blocking the production of prostaglandins which are responsible for the pain.

Provided you are not wishing to get pregnant, using the pill, transplant hormone patch or IUD may help with the pain.

 

Surgery

There are some instances where surgery is the last resort. Hysterectomy is the most drastic but in some cases, it is preferable to the monthly nightmare of experiencing excruciating, intolerable pain.

In the case of endometriosis, there have been some advances in the surgical treatment available involving excision of the endometrial tissue using keyhole surgery and so it is important to discuss these with your doctor

 

Conclusion

Whilst period pain is something that most women experience to a greater or lesser degree during their lives, for some of those women it can make the prospect of menstruation intolerable. In the past, many of these women would have been without hope of treatment but today there are many more options available

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