Painful Periods

Painful Periods

Eric Webb, MD

Dysmenorrhea is the medical term used to refer to painful periods. More than half of women experience pain with their periods. Dysmenorrhea is observed in two different types, primary or secondary dysmenorrhea.

Primary dysmenorrhea is the pain that comes from menstruation and is frequently referred to as menstrual cramps. The uterus is muscular organ with an interior cavity called the endometrial cavity. The lining of this cavity produces a group of chemical referred to as prostaglandins that are released just prior to menstruation. The uterine muscles contract in response to these chemicals which assists in shedding the lining of the endometrial cavity. The production of prostaglandins is most high at the beginning of menses and gradually decreases. High levels of prostaglandin can cause intense contractions of the uterus that results in pain. This kind of dysmenorrhea usually improves as women get older and often improves with giving birth.

In contrast, secondary dysmenorrhea is painful periods that are often the result of another problem in the reproductive system. In many cases, occurs as patients get older and the pain may worsen over time. Causes for secondary dysmenorrhea include endometriosisadenomyosis or uterine fibroids.

The evaluation of dysmenorrhea usually includes a pelvic exam or a pelvic ultrasound. When the diagnosis is unclear, some patients may undergo a surgery, laparoscopy, for further diagnosis and management.

With primary dysmenorrhea, treatment may include pain relievers, NSAIDs which target the production of prostaglandins, or birth control pills to improve and control menstrual flow. NSAIDs work best when taken before the first day of menses as they tend to decrease the amount of prostaglandins at the beginning of menstruation.

With secondary dysmenorrhea, the goal of therapy is usually to treat the underlying condition. Endometriosis may respond to medical or surgical interventions directed at suppressing menstruation. Uterine fibroids often require surgical interventions including uterine artery embolization or surgical removal of the fibroids. For patients who have completed their reproductive plans, hysterectomy may be done for either fibroids or endometriosis. In most cases, less invasive procedures are pursued before considering hysterectomy.

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