Period pain (menstrual cramps)

Types Of Dysmenorrhea

Mild pain and discomfort during menstrual periods are normal. However, excessive pain and cramping that interfere with your daily activity or work are not normal. Dysmenorrhea can be classified into two types:

Primary dysmenorrhea.

• This type of dysmenorrhea occurs due to menstrual pain that’s not only a symptom of an underlying gynecologic disorder. 

• It is the most common type of dysmenorrhea, affecting more than 50% of menstruating women.

• It is generally seen in younger girls soon after they attain menarche (puberty). 

• It can cause mild to severe menstrual pain and cramping which usually gets maximum at the starting of the cycle and then reduces in severity. 

Secondary dysmenorrhea.

• This type is a result of menstrual pain that’s a symptom of an underlying gynecologic disorder such as endometriosis, uterine fibroid, or pelvic inflammatory disease (PID).

• Generally, it starts later in life as compared to primary dysmenorrhea and its symptoms tend to get worse over time. 

• During the menstrual cycle, the severe pain and cramping begin even 2 or 3 days before the cycle starts and may continue even after it ends.

Symptoms Of Dysmenorrhoea

Menstrual cramps usually begin 2 to 3 days before your periods, peak 24 hours after the onset of your period, and subside in a day or two. 

Some of the common signs and symptoms of dysmenorrhea include the following:

• Cramping in the lower abdomen

• Pain in the lower abdomen

• Low back pain

• Pain radiating down the legs

• Breast tenderness

• Vomiting or nausea

• Feeling emotional or tearful

• Diarrhea or constipation

• Faintness

• Fatigue or tiredness

• Bloating

• Headache

Signs and symptoms of secondary dysmenorrhea are:

• Irregular periods

• Heavy bleeding during periods

• Vaginal discharge with a foul smell

• Pain during sexual intercourse

• Pain in your back passage (rectum)

While discussing painful periods, it is also important to know what normal periods are. It is equally prudent to know out for any red flags and check timely with your doctor. To read more 
Click Here

Causes Of Dysmenorrhoea

Primary dysmenorrhea

Prostaglandins are hormone-like substances that control the contractions of the uterus (womb). The cells that form the lining of the uterus begin to break down during periods and release large levels of prostaglandins.

Vasopressin is another hormone that is responsible for vasoconstriction which causes uterine contractions.

Women with primary dysmenorrhea are found to have excessive levels of prostaglandins and vasopressin. These naturally occurring chemicals constrict the blood vessels in the uterus, cutting off the oxygen supply to muscle tissue. This leads to muscle contractions and painful cramps. 

Secondary dysmenorrhea 

Various conditions that are associated with secondary dysmenorrhea include:

• Endometriosis: This is a condition in which the cells that form the lining of the uterus (the endometrium) grow outside the uterus. It causes internal bleeding, infection, and pelvic pain. 

• Uterine growths: Fibroids, cysts, and endometrial polyps (benign growths in the wall of the uterus) are the most common noncancerous tumors in women of childbearing age. They can cause severe abdominal pain and excessive bleeding during periods.

• Adenomyosis: This condition occurs when the lining of the uterus grows into the muscle of the uterus (womb). It can cause the uterus to get much bigger than it should be, along with abnormal bleeding, cramping, and pain.

• Pelvic inflammatory disease (PID): It is a severe female inflammatory reproductive organs disorder caused by bacterial infection of the genital tract such as a sexually transmitted infection. 

• Structural differences: Some women are born with structural differences in size and shape of their wombs that cause more painful periods.

Is it normal to have irregular periods? Why do periods change dates every month? Are you worried about your menstrual cycle and always wanted to ask these types of questions?
Here you can clear some doubts about your menstruation cycle by watching this video till the end.

Risk factors

Several risk factors associated with dysmenorrhea are:

1. Non-modifiable risk factors:

• Early age at menarche (started puberty at age 11 or younger)

• Heavy bleeding during periods (menorrhagia)

• Irregular menstrual bleeding (metrorrhagia)

• Family history of dysmenorrhea

• Age less than 30 years

• Infertility 

• Nulliparity (miscarriage, stillbirth, elective abortion or never given birth to a live baby)

2. Behavioral risk factors:

• Smoking tobacco

• Less intake of omega 3 fatty acids

• Body mass index (BMI) < 20 or > 30

• High consumption of caffeinated beverages

• Depression and anxiety

• High levels of stress

• Alcohol intake during menstruation cycle

Smoking causes many other diseases such as cancer, heart diseases, lung diseases, diabetes, and many chronic conditions. Don’t wait for the right time to quit it. Here we have an anti-smoking cessation range that will help you to stop your craving for smoking.
Explore Here

Diagnosis Of Dysmenorrhea

To diagnose dysmenorrhea, your doctor will likely take your medical history and perform a physical exam (pelvic exam). If they think an underlying disorder is causing your symptoms, they may perform other tests like:

Blood tests: These tests rule out any infectious process in the pelvic organs. These might include a complete blood count (CBC), erythrocyte sedimentation rate (ESR), and differential count (DC).

Urine tests: This test helps diagnose urinary tract infections (UTIs).

Sexually transmitted diseases tests: This panel of tests help determine any sexually transmitted diseases, such as chlamydia and syphilis. For a bacteria culture test, your doctor may take a sample of blood, stool, urine, skin, or mucus.

Ultrasonography: This imaging test uses high-frequency sound waves to create an image of the internal organs present in the lower abdomen of the body, including the pelvic cavity and reproductive system. This test helps in the evaluation of unexplained pelvic pain, inflammation, abnormal bleeding, or infection.

Magnetic resonance imaging (MRI): This test uses large magnets, radiofrequency, and a computer to make detailed images of internal organs and structures. It is particularly helpful in diagnosing endometriosis and adenomyosis of the uterus.

Laparoscopy: It is required when all non-invasive investigations fail to lead to a diagnosis. In this procedure, a thin fiber tube (which has a lens and a light) is inserted into an incision in the abdominal wall. This tube relays images of the inside of the abdomen or pelvis to a television screen. This procedure is also known as keyhole surgery or minimally invasive surgery.

Prevention Of Dysmenorrhea

Following are a few tips that can help you prevent dysmenorrhea:

Quit smoking

Smoking tobacco can cause severe menstrual cramps and is associated with a higher risk of dysmenorrhea. Quitting will not only help with dysmenorrhea but also improve your overall health.

Lose the extra kgs

Research has shown that overweight women are more at risk for dysmenorrhea. Losing and maintaining a proper weight may help reduce the severity of cramps.

Stay active

Light exercises, such as walking, jogging, or stretching, can help you produce chemicals that block pain. Therefore, make exercise a part of your lifestyle to prevent menstrual cramps in the long run and have pain-free periods. 

A study also found that exercise helps reduce stress, which is also one of the factors linked to dysmenorrhoea. 

Deaddict from alcohol and caffeinated beverages

Avoid or limit the intake of alcohol and other caffeinated drinks and beverages like sodas, coffee, and tea. They can increase vasoconstriction (the narrowing of blood vessels), which can further worsen the cramps during your menstruation cycle.

Practice yoga and meditation

Holistic living that includes yoga and meditation provides relief to the symptoms of dysmenorrhea.

To know what to eat and what to avoid during periods.
Click Here

Specialist To Visit

If you experience any of the symptoms of dysmenorrhoea it is important to visit your gynecologist and obstetrician at the earliest. These specialists can help you treat any conditions affecting the reproductive system.

Get a consultation from our team of trusted doctors.
Book Consultation Now

Treatment Of Dysmenorrhea

Dysmenorrhea can be treated with medicines and in a few cases with surgery. It depends on the severity and underlying cause of your pain. Here are some of the common treatment options for dysmenorrhea:

Pain relief medications:

NSAIDs are usually the first-line therapy for painful periods and should be tried for at least three menstrual cycles. They act by decreasing prostaglandin production. This consequently reduces prostaglandin concentration in menstrual fluid, leading to decreased uterine contractility and menstrual volume.

The most commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) are:

• Diclofenac

• Ibuprofen

• Ketoprofen

• Mefenamic acid

These drugs are most effective when started before the onset of symptoms and continued for 3 days.

These are usually safe and well tolerated. Side effects might include gastrointestinal symptoms, such as nausea, vomiting, and heartburn.

Combined oral contraceptive pills:

This is the second line of treatment. If NSAIDs alone are not sufficient, oral contraceptives might be combined with them. 

These medicines contain hormones (estrogen and progesterone) which prevent ovulation (the monthly release of an egg) and reduce the release of prostaglandins. This in turn, brings almost immediate relief from symptoms associated with menstruation: heavy periods, painful periods, and irregular bleeding.

These hormones are available as a pill, skin patch, flexible ring inserted into the vagina, or an intrauterine device (IUD). 

Progestin-only methods:

Progestins-only hormones show efficacy in the treatment of menstrual pain by causing endometrial atrophy and inhibiting ovulation. These are more suitable for patients with secondary dysmenorrhea related to endometriosis.

Various drugs and methods of delivery include:

• Desogestrel

• Medroxyprogesterone

• Intrauterine levonorgestrel-releasing device (IUS) 

• Subdermal implant with etonogestrel release
  
  

Managing underlying conditions:

In the case of secondary dysmenorrhea, it is important to identify and treat the root cause of menstrual cramps. Generally, in this type, the menstrual cramps are caused by underlying disorders, such as endometriosis, fibroids, adenomyosis, etc. 

For example, to treat endometriosis (the lining of the endometrium grows outside of the uterus), removal of the endometriotic tissue is done through surgery which can provide great relief in menstrual cramps.

Home-care For Dysmenorrhea

The following home care remedies and tips can go a long way in managing  dysmenorrhea:

Use A Heating Pad

Topical heat is an effective and low-cost natural method to manage dysmenorrhea. You can place a heating pad or a hot water pack over your lower abdominal area. The application of heat helps to improve the blood flow to the site of application and thus, aids in relieving pain.

If you do not have a heat pack at home, you can soak a towel in slightly hot water, squeeze it to drain excess water and apply it on the abdomen. You can also use a hot water bottle to do the same.

Exercise

Exercise helps to release the pain-relieving chemicals called endorphins and helps you to fight pain and cramps during periods. Moreover, exercising increases the circulation to the pelvic region and releases hormones to counteract the pain-inducing prostaglandins.

Make certain tweaks to your diet

Arachidonic acid is a fatty acid and works as a precursor in the production of prostaglandins. Intake of a low-fat diet, beans, fruits, and vegetables helps to lower the production of arachidonic acid. Therefore, switching to a healthy, clean diet may help to control symptoms of dysmenorrhea.
 

It is equally significant to be informed about what all food items to avoid during periods.
Foods that worsen your period pain!
Tap Here

Augment your diet with supplements

Vitamin E, omega-3 fatty acids, vitamin B1, vitamin B6 and magnesium supplements have also been found to be highly effective in giving relief from pain associated with menstrual cramps. 

Drink more water

It is a common myth that drinking water during periods causes more blood flow. In fact, drinking 6-8 glasses of water is the best way to not only prevent bloating but also to manage period pain. You can also add some lemon or mint to water or load up your intake of foods rich in water such as cucumbers and watermelons to increase your water intake.

Consume Herbal Teas

The following ingredients are easily found in Indian kitchens. Make herbal teas from them to combat period pain:

Fenugreek (Methi): Fenugreek consumption has shown positive results in many problems related to the menstrual cycle and reproduction. It is considered to relieve menstrual cramps and helps to treat irregular periods. You can consume fenugreek tea by boiling it in water and then straining its grains. You can add it to your meal too. 

Cumin (Jeera seeds): It is an Indian spice that helps to reduce period pain. Due to its relaxing effect, antioxidant, antispasmodic, and anti-inflammatory properties, it can relieve pain and spasms.

Ginger (Adrak): It has anti-inflammatory and analgesic properties that help to relieve menstrual pain associated with primary dysmenorrhea. It has great efficacy with no side effects.

Turmeric (Haldi): The use of curcumin for the treatment of different diseases is mentioned in Ayurveda. It also helps to reduce the production of prostaglandins which are involved in the pathogenesis of dysmenorrhea.

Apple Cider Vinegar: It contains a good amount of potassium and calcium that help to ease muscle cramping during periods. You can have it by mixing one teaspoon of apple cider vinegar in a glass of water. However, make sure to consume it using a stainless steel straw as it can erode teeth.

Cinnamon (Dalchini): It is another Indian spice that has excellent antispasmodic properties that help to reduce menstrual cramps and pain. It also helps in regulating menstrual irregularities, heavy menstrual bleeding, nausea, and vomiting with primary dysmenorrhea. You can have cinnamon powder with lukewarm water. You can also sprinkle it on your meals. 

Chamomile: It is rich in antioxidants and helps to relieve pain originating from primary dysmenorrhea. It has antispasmodic, analgesic, and anti-inflammatory properties. You can simply have it by boiling it in hot water and then straining it. It also improves mood swings during periods.

A quick perusal of more home care Do’s and Don'ts to deal with pain and cramps during your periods.
Read Here

Alternative Therapies Of Dysmenorrhea

Women who experience severe menstrual cramps can try alternative therapies to ease their symptoms. However, it is always better to consult your healthcare provider before starting any of these.

Massage with essential oils

Massage therapy shows effective results in women suffering from dysmenorrhea. In this therapy, essential oils such as Lavender oil, Cinnamon oil, Roman chamomile oil, Clary sage oil, and Marjoram oil are used which have antispasmodic, analgesic, and anti-inflammatory properties. 

You can massage your lower back and abdomen around bedtime for a restful sleep and relief from cramping.

Acupuncture and Acupressure therapy

Acupuncture is a traditional Chinese medicine therapy that involves pointed fine needles inserted in areas of the body known as acupuncture points. Acupuncture may improve to ease the symptoms associated with menstrual cramps and stimulate specific nerves and muscles, which in turn release natural pain-relieving hormones in the body.

However, more research is required for their recommendation, and further studies are needed to prove their effectiveness. They may be an alternative in women not interested in pharmacological management.

Transcutaneous Electrical Nerve Stimulation (TENS)

It is a noninvasive, inexpensive and portable therapy that delivers electrical currents through the skin. 

Several studies have investigated the effectiveness of TENS in reducing pain, decreasing the use of analgesics, and improving the quality of life in primary dysmenorrhea patients.

Yoga and meditation

Practicing yoga and meditation regularly has proven to relieve stress, manage anxiety, and pain management. A study shows that practicing yoga for 60 minutes once a week may also help to reduce period cramps.

Complications Of Dysmenorrhea

Primary dysmenorrhea presents with mild to severe abdominal pains and cramps which can affect the overall well-being and quality of life of a woman. However, primary dysmenorrhea is not linked to any underlying conditions and therefore shows no complications.

In the case of secondary dysmenorrhea, complications depend on the cause. These might include:

• Infertility: One of the problems caused by secondary dysmenorrhea is infertility or the inability to conceive a child.
  Endometriosis, for example, is an underlying condition associated with secondary dysmenorrhea which can change the shape of the pelvis and reproductive organs. It can make it difficult for the sperm to find the egg or deform the fallopian tubes in such a way that they are not able to pick up the egg after ovulation.

• Miscarriage: Serious hormonal imbalance can also lead to miscarriage or other complications associated with pregnancy. 

• Psychological stress: Irregular periods can be stressful, especially for women who are trying to conceive and plan a family. 

• Osteoporosis: Levels of estrogen play a vital role in overall bone health. Lack of estrogen production may cause a high risk of brittle or weak bones and joints. 

• Anemia: If any structural problem such as the size and shape of the uterus is causing dysmenorrhea, it may cause heavy bleeding during periods which may lead to anemia. 

• Insomnia: Painful cramps can severely affect the sleep cycle or cause insomnia.

Consulting the right expert for your reproductive health issues can help you get the right medical advice. Here is a list of types of medical experts you can consult.
Read On

Living With Dysmenorrhea

Painful periods poorly affect daily work or activities of females. Young girls end up missing school. It also impacts academic or work performance in terms of concentration, socialization and achievement. Dysmenorrhea could also limit women's participation in sports or social events. Sleep disturbances due to menstrual pain further hurt the productivity of women.

Painful periods are the main cause of recurrent short-term school absence in adolescent girls and a common problem in women of reproductive age.

If you are experiencing symptoms of dysmenorrhea or it is very challenging for you just simply follow these tips to ease your menstrual cramps:

• During menstruation, getting a good amount of rest is essential. You can use a heating pad or hot bottle of water to ease the pain. A warm bath can also help to reduce the overall pain.

• Certain foods can help to ease your cramps such as fruits, vegetables, whole grains, legumes, nuts, and seeds. Eating a healthy diet decreases inflammation in the body and also helps to tame menstrual cramps.

• Constipation, bloating and an upset stomach are other common problems for women with dysmenorrhea, therefore it is advised to hydrate yourself and include fiber-rich food to relieve the symptoms.

• Diet rich in vitamin E, omega-3 fatty acids, vitamin B1, vitamin B6 and magnesium has been found to be highly effective in giving relief from pain associated with menstrual cramps. 

• Regular exercise such as walking, jogging, and stretching improves blood circulation and helps nutrients and oxygen flow to all the systems of the body. Certain chemicals (endorphins) are released during exercise which helps to block the pain.

• Avoid caffeinated drinks and beverages as they may increase vasoconstriction (the narrowing of blood vessels), which can further worsen cramps during your menstruation cycle.

• Mild and moderate dysmenorrhea usually responds well to NSAIDs.

Menstruation comes with its own share of myths and misconceptions. They only add to the confusion surrounding periods. Time to get period myths busted.
Tap Here