Painful Menstrual Periods

While many women have some form of discomfort during their periods, some have pain so severe that it stops them doing normal daily activities. Such severe menstrual pain is known as dysmenorrhoea. It is a common condition, affecting up to half of women at some time in their lives. About 10 to 15 women in 100 have bouts of dysmenorrhoea that may be incapacitating. Women describe a crampy pain in the lower abdomen that may spread to the lower back or the inside thigh. It may be a sharp pain that comes and goes, or a dull ache, or a combination of both.

The two types of Dysmenorrhoea are:

  • Primary dysmenorrhoea, which occurs in otherwise healthy women, starting usually in the teenage years soon after periods start; up to half of teenagers may have primary dysmenorrhoea during some periods.
  • Secondary dysmenorrhoea, which is often caused by an underlying gynaecological disorder. It can occur at any age after periods start, but most commonly is seen in women over 30.

Primary Dysmenorrhoea

Primary dysmenorrhoea usually begins within a year of a girl’s first period. It is one of the main causes of absence from school or work among young women.
Primary dysmenorrhoea is more likely to occur in young women who:

  • Started their period very young
  • Have not given birth
  • Have heavy or prolonged periods
  • Smoke
  • Have a family history of dysmenorrhoea

The cause: During menstruation, the hormone prostaglandin is released in the uterus. Prostaglandin levels tend to be high in women with severe menstrual pain, particularly during the first two days of their period.

Secondary Dysmenorrhoea

Secondary dysmenorrhoea can be caused by many different conditions, including:

  • Endometriosis, where cells of the inner lining of the uterus (the endometrium) exist outside the uterus and grow onto pelvic tissue including the surfaces of the various ligaments of the pelvis and sometimes the ovaries
  • Pelvic inflammatory a disease where an infection spreads from the vagina to the cervix, endometrium and fallopian tubes
  • Appendicitis a bowel infection
  • Adenomyosis, where endometriosis occurs within the muscle of the uterine wall
  • Fibroids, which are benign (non-cancerous) growths that occur singly or in groups
  • Uterine polyps
  • An IUD
  • Cervical stenosis, which is a narrowing or blockage of the cervix
  • Congenital abnormalities
  • Pelvic congestion
  • Fluid-filled sacs

Diagnostic Tests

  • Urine test
  • Blood tests
  • Swabs from your cervix
  • Diagnostic scan: An ultrasound scan is used to check for problems such as ectopic pregnancy, ovarian cysts, fibroids, endometriosis or a dislodged IUD.
  • Diagnostic hysteroscopy: Hysteroscopy is a procedure to examine the inside of the uterus. The doctor uses a thin telescope called a hysteroscope.
  • Diagnostic laparoscopy: Laparoscopy is keyhole surgery that allows the doctor to look directly into the abdomen and pelvis, and if necessary, operate on the abdominal and pelvic organs.

Medical (non-surgical) Treatment of Dysmenorrhoea

Medical Treatments:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) help many women with dysmenorrhoea and are generally an initial treatment
  • COX-2 inhibitors are similar to NSAIDs but require a doctor’s prescription
  • Paracetamol and paracetamol with codeine
  • Contraceptive pills and devices
  • Antibiotics
  • Acupuncture
  • TENS

Please note that your doctor can and will discuss the above points in more detail with you.