Painful menstruation is the most common gynecological complaint. Most women probably experience some menstrual discomfort from time to time, typically mild cramps or bloating. But for some women the pain is severe and may interfere with normal activities. Dysmenorrhea may include nausea and vomiting, dizziness, backache, abdominal pain, and labor-like pain that comes in waves (probably associated with uterine contractions).

What causes dysmenorrhea?

Painful menstruation which is not caused by another disease or condition is called primary dysmenorrhea. Doctors believe it is caused by chemicals known as prostaglandins, which stimulate smooth muscle tissue. The uterus is a muscle. Prostaglandins in the uterus cause it to tighten, inhibiting the blood vessels’ ability to supply it with oxygen. The aching feeling that results is similar to that felt by weightlifters who have worked out too hard.

It appears that the release of prostaglandin is stimulated by ovulation, so young women who have started menstruating but are not yet ovulating, women who do not ovulate in a particular cycle, or women near menopause who have stopped ovulating, may be less likely to experience pain.

When painful menstruation is caused by other conditions, such as pelvic lesions, it is called secondary dysmenorrhea. It is important that anyone experiencing dysmenorrhea receive a complete gynecological exam, to rule out any other diseases or conditions.

Is it all in my mind?

For a long time, doctors dismissed menstrual pain as being mostly psychological. Their advice to women was “Get used to it”. Fortunately, most gynecologists today are likely to take complaints of dysmenorrhea more seriously and will try to investigate the causes and look for solutions.

Of course, a woman who has experienced pain and nausea may begin to anticipate her periods with dread. Occasionally a woman may have negative feelings about menstruation or her reproductive organs that can lead to anxiety and unhappiness. Anxiety, tension, depression and other emotional conditions can lead to suffering and make it more difficult to cope with discomfort. If you suspect that emotional problems are contributing to your dysmenorrhea, ask your doctor about counseling.

What can I do about the pain?

Over-the-counter pain relievers such as aspirin, Tylenol, and ibuprofen are often helpful. Heating pads and hot water bottles applied to the abdomen, as well as massage, can relax the muscles and relieve cramps. Women who exercise regularly tend to report less menstrual pain. Aerobic exercise such as walking, running and swimming seems to be the most effective.

If these methods do not help, your doctor may want to try prescription medications including stronger pain killers, or prostaglandin inhibitors. In some cases birth control pills are effective, probably because they prevent ovulation.

Some women try dietary adjustments, herbs, or nutritional supplements. Currently there is no scientific evidence to indicate that these methods will work. However, some women report that reducing salt in the diet helps relieve relieve bloating and cramps. Others feel that reducing or eliminating caffeine is helpful.

What if the cause is more serious?

If you suddenly start to experience more pain than usual or notice a significant change in your periods, you should consult your doctor.

Some of the conditions which can lead to dysmenorrhea include:

• Endometriosis
• Fibroids
• Pelvic inflammatory disease

What about pain between periods?

Some women experience pain about halfway through the menstrual cycle, at the time of ovulation. This is a sharp pain on one side of the lower abdomen. Apparently it is caused by the egg bursting out of the ovary. Usually this lasts only a few minutes, but if it lasts longer a mild painkiller will usually help.

What else should I know?

The Endometriosis Association has more information.
The American Chronic Pain Association may be able to help.
See our page of helpful links.

© 2005 Rosemary K. West