Painful periods: causes and care

 

Painful periods and menstrual cramps are called dysmenorrhea. They are common problems, but affect some women more seriously than others.

“Some women don’t have much trouble at all with their periods, while others have so much pain they need to miss work or school,” says Dr. Yolanda Kirkham, a gynecologist at Women’s College Hospital. “Also, everybody’s pain tolerance is different.”

Causes

One of the most common causes of menstrual cramps is uterine muscle contractions.

“The uterine muscles contract to help shed the lining of the uterus, and to control the amount of bleeding,” Dr. Kirkham explains. “The contractions are triggered by hormones called prostaglandins that are released by the body.”

This process of releasing prostaglandins that trigger uterine contractions usually happens during ovulatory cycles, when a woman has released her monthly egg.

“We call this primary dysmenorrhea when it’s caused by the uterine muscle activity,” Dr. Kirkham says. “But painful periods can also be due to a secondary reason, such as other medical conditions.”

Conditions that can cause painful periods include:

• endometriosis (when uterine lining grows outside the uterus into the pelvis or abdomen)
• adenomyosis (when the uterine lining grows into the uterine wall)
• infections, such as pelvic inflammatory disease
• structural factors such as fibroids, polyps, or abnormal anatomy

Lifestyle choices

Some lifestyle modifications can help manage painful periods.

“Various studies have shown that exercising three times per week can decrease menstrual pain, and also improve mood and stress levels,” Dr. Kirkham says.

In contrast, smoking has been linked to increased menstrual pain.

“So the modifiable things that women can do to manage menstrual pain include exercising, not smoking, considering acupuncture or heat packs, and including vitamin B and fish in their diet,” Dr. Kirkham says.

Over-the-counter treatment

For treating menstrual cramps, over-the-counter medications are a good place to start. These include acetaminophen, as well as anti-inflammatory medications such as ibuprofen and naproxen.

“Anti-inflammatory medications are helpful because they actually block the production of prostaglandins, which trigger the uterine contractions that cause the pain,” Dr. Kirkham says.

Dr. Kirkham recommends that women start taking over-the-counter medication as soon as any cramping begins, even if it’s before their period starts.

“They may not be bleeding yet, but if they’re already experiencing cramps, they can start the medication early to decrease both the bleeding as well as the pain,” she says.

She also notes that it’s important to take an effective dose.

“Some studies have found that women may not be taking enough over-the-counter medication; they’re not reaching the recommended dose,” Dr. Kirkham says. Read the label to find the recommended dose, as well as the suggested timing of doses.

Further options

If over-the-counter medication is not managing the pain, Dr. Kirkham recommends seeing a doctor to talk about other management options, or to rule out medical conditions that might be causing the pain.

Birth control pills, or other hormonal contraceptives, can often relieve painful periods.

“We want to target the treatment to the cause,” Dr. Kirkham says. “Hormonal contraceptives help to control the pain because they control the menstrual cycle. The birth control pill suppresses ovulation and decreases prostaglandin production, so it also decreases uterine contractions as well as bleeding.”

The most common secondary cause of painful periods is endometriosis. Hormonal contraceptives as well as the progesterone intrauterine system, or IUD, can help suppress endometriosis, decrease bleeding, and prevent consequences of untreated endometriosis such as infertility and chronic pain. Those are the first-line treatments for endometriosis, but some cases may require minimally-invasive surgery.