Dysmenorrhea: Different Types, Underlying Causes, and Potential Remedies
Period pain, also known as dysmenorrhea, is a common condition that affects many women during or around menstruation. This article aims to provide an overview of the different types of dysmenorrhea, their causes, and potential treatments.
Primary dysmenorrhea, which occurs as a result of menstruation alone, is believed to be caused by prostaglandins, hormone-like substances that control inflammation. On the other hand, secondary dysmenorrhea is a type of period pain that occurs as a result of another medical condition, such as endometriosis, pelvic inflammatory disease (PID), uterine fibroids, adenomyosis, or complications from intrauterine devices (IUDs).
Secondary dysmenorrhea, particularly endometriosis, can be a result of the presence of uterine-like tissue outside the uterus, causing inflammation and intense menstrual pain. PID, an infection often caused by sexually transmitted diseases, leads to inflammation and scarring of reproductive organs, resulting in painful periods. Fibroids, benign tumors in the uterine muscle, contribute to secondary dysmenorrhea by causing heavy bleeding and pelvic pain.
Treatment for secondary dysmenorrhea depends on the underlying cause but generally includes medical and sometimes surgical options. Medical treatments often involve hormonal therapies such as combined oral contraceptives (COCs) containing estrogen and progesterone, which regulate hormone levels and reduce prostaglandin production to alleviate pain. Progestin-only treatments, including hormonal IUDs and implants, are especially effective for endometriosis by thinning the uterine lining and suppressing ovulation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are also commonly used to reduce inflammation and pain.
For severe or refractory cases, surgical interventions such as laparoscopic removal of endometrial lesions, removal of fibroids, endometrial ablation, or hysterectomy may be indicated, particularly when childbearing is not a concern. Supportive measures like heat therapy, physical activity, and stress management techniques can help alleviate symptoms as adjuncts.
If an IUD is identified as a pain source causing secondary dysmenorrhea, removal may be necessary.
In addition to medical treatments, strategies for preventing period pain include maintaining a healthy lifestyle, managing stress, quitting smoking, and considering hormonal birth control methods. Certain risk factors may contribute to primary dysmenorrhea, including smoking, stress, anxiety or depression, having excess weight, trying to lose weight, beginning periods at an early age, never having been pregnant, and a family history of painful periods.
Period pain can range from mild to severe and may affect a person's ability to carry out daily tasks. It can cause a cramping sensation in the abdomen, burning pain, pain that feels like trapped gas, and pain that radiates to the back, hips, or legs.
If periods become much heavier or more painful than normal, frequently cause a person to miss work or school, over-the-counter pain medications do not work, or are accompanied by other symptoms such as pain during or after sex, bleeding between periods, frequent need to urinate, bad-smelling or grey discharge, it is important to speak with a doctor.
People with dysmenorrhea can face difficulty getting medical care due to the belief that painful periods are normal and prejudice as a result of sexism, racism, and other sources of bias. If a person faces difficulty getting a diagnosis, there are things they can do to advocate for themselves, such as describing or writing down a concise list of symptoms, being honest about the level of pain, asking what else could be causing the pain, asking what the doctor will do if the pain continues or gets worse, asking the doctor to memorialize their decision not to investigate or treat the pain in the person's chart, seeking an opinion from another doctor or moving to another healthcare center, and having someone else accompany them to appointments for support.
Period pain can also be accompanied by digestive symptoms such as nausea or vomiting, bloating, diarrhea, constipation, and headaches. Effective management combines addressing the specific cause (like infection or lesions) with symptom relief through hormonal and anti-inflammatory treatments, and surgery if needed.
Sources:
- Mayo Clinic
- Johns Hopkins Medicine
- American College of Obstetricians and Gynecologists
- Epidemiologic Reviews
- Chronic inflammation and intense pain during menstruation, known as secondary dysmenorrhea, can be attributable to medical conditions like endometriosis, pelvic inflammatory disease (PID), and uterine fibroids.
- In treating secondary dysmenorrhea, therapies and treatments may include hormonal therapies like combined oral contraceptives (COCs) and progestin-only treatments such as hormonal IUDs and implants.
- Embracing a health-and-wellness lifestyle, managing stress, and considering mental-health support can help prevent or alleviate period pain, particularly for cases of primary dysmenorrhea.
- A skin-care regime might also serve as a beneficial adjunct in managing period pain by reducing stress and promoting relaxation.
- Despite advances in science and the understanding of period pain, women may still face challenges getting a proper diagnosis and treatment due to biased beliefs and discrimination, necessitating self-advocacy and seeking multiple opinions.
- Various chronic-diseases and medical-conditions can cause or exacerbate period pain, making it necessary to address the primary issue through a comprehensive approach utilizing fitness-and-exercise, therapies-and-treatments, and lifestyle modifications.
