More than half of women have some pain for 1-2 days each month during their periods.
Sometimes, this pain is severe and interferes with normal activities. The pain is usually
located in the lower abdomen but it can also radiate to the lower back and/or thighs.
Pain of this degree is not normal and is classified as dysmenorrhea. Patients with
severe menstrual cramps that last more than 2-3 days should see their gynecologist.
The uterus is made of smooth muscle fibers. During the period it contracts and this can cause discomfort. These contractions are triggered by prostaglandins, chemicals that are produced in the lining of the uterus. When the pain during menses is strictly caused by these normal and cyclical changes in the muscle and lining of the uterus it is classified as primary dysmenorrhea.
Secondary dysmenorrhea is the term used when the painful periods are related to
causes other than what was mentioned above. In these cases the pain usually begins
tater in life and usually lasts longer. Some of the most common causes of secondary
Endometriosis: a condition in which tissue from the lining of the uterus can also
grow outside of the uterus.
Fibroids: benign muscle tumors of the uterus that can also cause pain and heavy
Adenomyosis: a condition in which tissue from the lining of the uterus can also grow within the muscle fibers of the uterus.
During evaluation of a patient with painful periods the goal is to differentiate those
patients with primary versus secondary dysmenorrhea. To accomplish this, your doctor
will obtain a medical history and perform a pelvic examination. An ultrasound
examination is also commonly used to evaluate the anatomy of the uterus and ovaries
and to identify any potential anatomical causes of the pain. In certain cases, if
endometriosis is suspected, a laparoscopy may be recommended. In this surgical
procedure a small camera is introduced in the abdomen, letting the doctor view the
The treatment of painful periods will depend on the cause of the pain. If a cause like
fibroids, endometriosis or adenomyosis is found, the treatment will seek to remove or
reducing these specific findings.
In those cases in which the pain is deemed to be caused by the normal exposure of the
uterus to prostaglandins, non-steroidal anti-inflammatory drugs like Advil. Aleve, and
Ibuprofen may be recommended. This group of medications blocks the production of
prostaglandins and is more effective when taken at the first sign of the period or pain.
Another medication commonly used is hormonal contraception (birth control pills).
These limit the growth of the lining of the uterus so less prostaglandin is produced. This
translates in to less contractility of the uterus, less blood flow, and less pain. They may
also decrease the growth of fibroids or endometriosis.
- Regular exercise produces chemicals that may block the pain. For some patients
a regular exercise regimen, especially around their menstrual period may
decrease the symptoms.
- Heat: a warm bath or a heating pad on the abdominal/pelvic area.
- Relaxation, yoga, acupuncture: These techniques can help some patients cope
with the pain.
If fibroids are causing the pain your doctor may recommend surgery. Depending on the
size and location of the fibroids, as well as the patient’s preference, the benign tumors
or the whole uterus can be removed.
In patients with endometrial the endometrial tissue that is growing outside the uterus
can be removed or destroyed. This tissue may return after surgery, but removing it may
reduce pain for a significant period of time. In severe cases, when other treatment
options have failed to treat the symptoms, removal of the uterus may be done.