Menstruation, painful

Considerations:
Painful menstruation affects over half of menstruating women and is the leading cause of lost time from school and work among women of childbearing age. This pain may precede menstruation by several days or may accompany it, and usually subsides as bleeding tapers off.

Some pain during menstruation is normal; excessive pain is not. Dysmenorrhea refers to menstrual pain severe enough to limit normal activities and require medication.

There are several types of dysmenorrhea:
Primary dysmenorrhea refers to menstrual pain that occurs in otherwise healthy women. Prostaglandin activity is thought to be a causative factor because prostaglandin levels have been found to be much higher in women with dysmenorrhea than in women who experience only mild or no menstrual pain.

Secondary dysmenorrhea is menstrual pain that is attributed to some underlying disease process or structural abnormality either within or outside the uterus (for example, pelvic inflammatory disease , fibroids , endometriosis , adhesion , or uterine displacement). Endometriosis is the most common cause of secondary dysmenorrhea and is frequently misdiagnosed as primary dysmenorrhea.

Psychogenic dysmenorrhea may be attributed to emotional stress or true anxiety . It can also be caused by a lack of information regarding menstruation or negative attitudes about the process passed from mother to daughter.

Membranous dysmenorrhea is intense cramping caused by passage of endometrial (uterine lining) tissue being passed through an undilated cervix . This condition is quite rare.

The presence of an IUD ( intrauterine device for contraception) may also be a potential cause of menstrual pain.

The incidence of menstrual pain is greatest in women in the late teens and twenties, then declines with age. It does not appear to be affected by childbearing. An estimated 10 to 15% of women experience menstrual pain each month severe enough to prevent normal daily function at school, work, or home. The majority of women will suffer this degree of disability at least once during their reproductive years. Increased risk is associated with younger age, IUD use, multiple sexual partners, and past medical history of any of the conditions associated with secondary dysmenorrhea.

Common Causes:

Note: There may be other causes of menstrual pain . This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as quality, time course, aggravating factors, relieving factors, and associated complaints. Use the Symptom Analysis option to explore the possible explanations for menstrual pain, occurring alone or in combination with other problems.

Home Care:
Ibuprofen or acetaminophen may relieve mild menstrual pain . Antiprostaglandins are quite effective in the management of moderate to more severe pain. These include higher doses of aspirin, as directed by a health care provider. However, this is sometimes hard for patients to tolerate. Other nonsteroidal anti-inflammatories may be used; ibuprofen is the most common. To work effectively, these medications must be taken at the first appearance of symptoms. Some women experience several days of pain which may require the use of narcotic pain relievers such as codeine.

Some relief may be provided by applying a heating pad to the abdomen, effleurage (a light circular massage with the fingertips), drinking warm beverages, taking a warm shower, performing waist-bending and pelvic rocking exercises, and walking.

Emotional support, psychological counseling, or antidepressants may be helpful for those women who have inadequate relief of chronic pain.

If pain continues, consult your health care provider.

Call Your Healthcare Provider If:

  • the pain is severe.
  • menstrual periods always hurt, or if other unexplained symptoms accompany the pain.



What to Expect:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting your symptom in detail may include:

  • menstrual history
    • Are you a woman presently in a menstruating age?
    • Are you sexually active?
    • Do you use birth control ? What type?

  • quality
    • Was the previous menstrual period a normal amount?
    • Do you use tampons with menstruation?
    • Do you normally have regular periods?
    • Do you have heavy menstrual bleeding ( menorrhagia )?

    • Do you have prolonged menstrual bleeding (more than five days per menstrual period)?
    • Describe the pain (sharp, dull, intermittent, constant, aching, cramping).

  • time pattern
    • When was the last menstrual period?
    • What was the age at which you had your first menstrual period?
    • How long have you had the same menses pattern?
    • When did you begin to have painful menstruation?
    • Is it getting worse or better?
    • When in your menstrual cycle do you experience the pain?

  • relieving factors
    • What have you done to try to relieve the discomfort?
      • How effective was it?

    • What has been effective in the past for you?

  • other
    • What other symptoms are also present?

The physical examination will probably include a pelvic examination.

Diagnostic tests that may be performed include:

Intervention:

  • Oral contraceptives may be prescribed as an attempt to alleviate menstrual pain . If not needed for contraception, they may be discontinued after 6 to 12 months. Many women note continued freedom from symptoms despite stopping the medication.
  • Surgery may be indicated for those women unable to obtain adequate pain relief or control. Procedures may range from removal of cysts , polyps, adhesions , or fibroids to complete hysterectomy in cases of extreme endometriosis .
  • Prescription medications may be used for endometriosis.
  • For pain caused by IUD, removal of the IUD and alternative birth control methods may be needed.
  • Antibiotics may be indicated for pelvic inflammatory disease .

After seeing your health care provider:
You may want to add a diagnosis related to painful menstruation to your personal medical record.


This is an illustration of the female reproductive system. Both internal and external views are shown here.