Painful Menstrual Periods / Dysmenorrhea - Symptom Evaluation

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Pain during menstrual periods may be due to a uterine or pelvic cause, especially in older women.

Pain that accompanies cyclic menstrual periods is called dysmenorrhea. It interferes with routine life especially in young girls. Ten percent women are actually incapacitated for 1 to 3 days each month due to painful menstruation. Menstrual pain may also be present in older women; these cases are often due to a specific cause. Older women should therefore undergo testing to find out the cause of the pain, especially in the case of new onset pain.

The causes of primary and secondary dysmenorrhea are listed below:

Primary Dysmenorrhea:

Primary dysmenorrhea usually affects young girls. It occurs due to the release of hormone-like substances called prostaglandins during menstruation. The prostaglandins result in contraction of the uterine muscles. The blood vessels thus get compressed leading to reduced blood supply to the muscles. This results in pain.

Prostaglandins are released during cycles in which the ovum or egg is released. In the first year of menstruation, the egg may not be released in all the cycles, i.e. the cycles may be anovulatory. These cycles are usually painless.

The pain in primary dysmenorrhea is usually most severe on the first day and may feel like severe cramps. It usually lasts for 1 to 2 days. It may be accompanied by nausea, vomiting, loose stools, dizziness, headache and fatigue.

Secondary Dysmenorrhea:

Secondary dysmenorrhea usually occurs due to a problem in the female reproductive organs or the pelvis. It is usually seen in older women. The symptoms usually begin just before the bleeding starts and last till just after the bleeding has stopped. Causes of secondary dysmenorrhea are listed below:

Conditions that affect the pelvis:

Endometriosis: Endometriosis is a condition where the cells similar to those lining the uterus grow outside the uterus. They also undergo changes under hormonal influence, like the uterine lining, and bleed during the menstrual cycle, giving rise to pain.

Pelvic inflammatory disease: Pelvic inflammatory disease refers to infection of the uterus, fallopian tubes, ovaries or the pelvis. The infection may travel up from the vagina and cervix, as in the case of sexually transmitted diseases, or may follow childbirth or surgical procedures. Along with menstrual pain, pelvic pain, fever and vaginal discharge may be present.

Pelvic congestion syndrome: Pelvic congestion syndrome occurs due to the presence of dilated veins in the pelvis. The pain is felt during menstrual periods, following intercourse, prolonged standing or during pregnancy. Associated symptoms may include abnormal menstrual bleeding, irritable bladder, vaginal discharge and dilated veins in the vulva, buttocks and thighs.

Allen-Masters syndrome: Allen-Masters syndrome is condition where the pelvic muscles are damaged and allow excessive motility of the cervix. The damage is often a result of traumatic deliveries.

Conditions that affect the uterus

Adenomyosis: Adenomyosis is a condition where the lining of the uterus grows into the muscle wall. Along with severe menstrual pain that lasts throughout the period, the patient may also experience heavy bleeding with bleeding between periods and pain during intercourse.

Fibroids: Fibroids are benign muscle tumors arising from the uterine wall. Along with menstrual pain, they also cause excessive bleeding, pelvic discomfort and pain, pain during intercourse and symptoms due to pressure over the bladder and rectum.

Uterine polyps: Uterine polyps are small growths that arise from the uterus and remain attached to the uterus by a thin stalk. They may cause excessive and irregular menstrual bleeding and may be one of the causes of infertility.

Intrauterine adhesions: Damage to the inner lining of the uterus results in the formation of scar tissues and adhesion between the walls of the uterus. The damage occurs usually due to surgical procedures like dilatation and curettage (D&C) or removal of fibroids. It could also occur due to insertion of an intrauterine device like Copper –T or infection of the uterus. The patient suffers from infertility or repeated miscarriages. Pain may occur during menstruation if the adhesions cause obstruction to the flow of menstrual blood.

Congenital malformations: The presence of congenital abnormalities in the uterus like bicornate uterus (uterus with two horns) and subseptate uterus (uterus with a partition within) can result in painful menstruation.

Intrauterine contraceptive device: An intrauterine contraceptive device like Copper-T could cause cramps during menstruation.

Conditions that affect the cervix and vagina

Cervical stenosis or occlusion: Cervical stenosis is a condition where the opening of the uterine cervix is narrowed, either partially or completely. It may be a condition present from birth or may arise later in life due to trauma, surgical procedures, infections, cancer or radiation. The patient is at an increased risk for infertility and endometriosis.

Transverse vaginal septum: A transverse vaginal septum occurs as a birth defect. The menstrual blood is unable to flow out due to the septum leading to menstrual cramps.

Conditions that affect the ovaries

Ovarian cysts and tumors: Ovarian cysts are fluid-filled sacs in the ovary which are usually benign but may rarely be cancerous. They may, in addition, cause symptoms like irregular menstruation, discomfort during intercourse and problems with bowel and bladder function.


1. Which doctor should I visit in case I have painful menstrual periods?

You should visit a gynecologist to get treated for painful menstrual periods.

2. How are painful menstrual periods treated?

If there is a definite cause for the painful menstrual periods, then treating the cause can provide relief. Over-the-counter painkillers may be used to treat primary dysmenorrhea. Hormonal treatment with oral contraceptives may help in cases not responding to painkillers. General measures like application of heat, self massage over the lower abdomen, a healthy diet, regular exercise and stress reduction may also be helpful.

3. Are there any risk factors associated with painful menstruation?

Some factors that could be associated with more severe pain during menstruation are an early age at menarche, long menstrual periods, heavy menstrual flow, having no children in the past, a positive history of painful menstruation of other women in the family, obesity, smoking and alcohol consumption.

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hi i am 23 years old my periods have never been normal. whenever im on my periods i experience severe pain from my lower abdomin to my lower back.and heavy menstruation as well. what could be the course as the pain is unbearable its my affecting my whole body my muscle joints etc...please help Purity
Purity17 Wednesday, August 28, 2013
I'm 23 years old mostly healthy. But when I was on the pill a couple of years ago, whenever I got my period it would feel like something in my lower abdomen would get swollen and cause a tonnnnn of pain. From passing gas, stool and urine to wearing jeans and getting too full after I eat sometimes the pain would bring me to me knees in pain. Its tender to the touch and I have to stand up slowly so I can get used to the pain. I cant wear jeans because it hurts too much. Pain killers and anti inflammatory's dont work. I have been off the pill for 2 years and due to abnormal bleeding while off of it I decided to go back on it. Not ONE time did I get that pain while I was off the pill. Well guess what, the pain is back and this is my first period while on it and its back with a vengeance and quite frankly I'm scared to keep taking the pill, but I dont want to go back to the abnormal bleeding like I had. I been to GI doctor when it first started and had an EGD, plenty of blood work and everything came up negitive. I know I need to go back to my gyno but all the tests add up when it comes to money and I would love to say its ok but its not. And I feel like Im going in a circle. Past history of me: IBS, Cysts on ovaries [gone now], Internal Hemroids, HPV (Internal) I not looking for a miricle but it someone could give me an idea on where to go from here, or let me know Im not alone that would be great. Thank You for your Time, Lindsay
LindsayMariie Sunday, March 31, 2013
i have excessive bleedind in menstrual period and have very pain from period starting to end. took many advoice and medicine as i can but not getting relief can you say why it is age 37 f married on 1996 have 2 sons 15 th yrs and 10th yrs old family planning operation has done no any serious problem shows in sonography as per doctor's opinion
mona37 Tuesday, February 12, 2013
M a 14 yr old gal. M suffering 4m a severe abdominal pain since last 3 yrs during my periods. Da pain is unbearable n intolerable. It last for 3days from da dat of menstruation. Itz so painful dat i becum unable 2 get up 4m my bed. I've tried alot 2 get out of diz prblm bt m unable... Oftn i hv 2 miss my tutions n school 4 diz pain. Itz killing me. Plz suggest me 2 sort diz out...
Guest Wednesday, January 2, 2013
I had a cyst on my right ovary and it had ruptured and left some fluid on my ovary and the doctor didn't remove the fluid. And ever since that everytime my menstrual period hits i am in severe pain and i can feel it from my ovary. It is worse than cramps and lasts forever. And the pain comes on the first and last day. And i am just trying to find out what options i have to be able to get rid of this pain. I can't live with it anymore. The pain is so bad i am buckled over and curled in a ball and i can't do that because i have a 3 year old kid to take care of.
hschaub87 Friday, September 28, 2012
hi, i m a 39 yr old, mother of 2 children, both born by LSCS, n the youngest one is now 5 1/2 yrs old.... i took contraceptiv pills for almost 4 yrs. then i hav to stop it becoz i had intermestrual bleeding [spotting] while on pills... since then i m having irregular spottings and scanty periods... for last 3 cycles i develop unbearable lower abdominal pain accompanied with spotting at regular intervals of about 30 days with scanty period.. the pain is so much intense that makes me immovable or even stand is not releaved by any oral medications...i hav to take inj..for this...i hav undergone USG which was normal...what should i do..plz suggest
SANGITABHARGAVA Monday, September 3, 2012
In the Traditional Chinese Medicine, Dysmenorrhea refers to regular lower abdominal pain, during menstruation or before and after menstruation, or pain involving the waist and sacrum, or even unbearable pain. Regular lower abdominal distending pain or sharp pain during or before menstruation is usually caused by qi stagnation and blood stasis; lower abdominal pain alleviated with warmth is often due to cold coagulation or yang asthenia; lower abdominal dull pain during or after menstruation is frequently brought about by asthenia of both qi and blood and malnutrition of the uterus.
TCMAngel Friday, March 9, 2012

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