Dysmenorrhea “period pain”: Symptoms, diagnosis and treatment

Dysmenorrhea is a problem that can significantly affect women’s quality of life. It affects about 60% of women in childbearing age, to a greater or lesser degree, and is one of the most frequent reasons for consultation gynaecologists may find in our daily clinical practice. In this post we are going to detail what it consists of and what possible solutions may have.

What does dysmenorrhea means?

Dysmenorrhea is pain located in the lower half of the abdomen, in the pelvic area. It is related to menstruation and according to its etymology it’s a term composed of the prefix “dys” (difficult, defective), the Greek noun “men” (moon, lunar cycle) and “roía” (flow, from the verb to flow). The pain can start appearing even before the bleeding begins, during the bleeding, and days afterward. It’s not always related to the amount discharged, but it can be associated with the expulsion of clots.

Types

According to its causes, we may distinguish between two types:

• Primary dysmenorrhea: the cause that originates it is unknown. It’s believed that the pain is produced by the uterine contractions themselves. A molecule called prostaglandin is involved.
• Secondary dysmenorrhea: it’s due to some structural cause, usually of a gynaecological type, most frequent, the beginning of endometriosis. Other causes of secondary dysmenorrhea are uterine malformations, the presence of fibroids, infections or IUDs.

What are the dysmenorrhea symptoms?

It’s a pain in the lower abdomen, which is usually perceived as sharp, intermittent cramps, although sometimes it causes a dull and constant ache. Sometimes it can radiate to the back or lower extremities.

There are a number of symptoms that may come with this pain and that are also related to the menstrual cycle. Such as headache, fatigue, nausea and vomiting and intestinal rhythm disturbances (constipation / diarrhea).

How can we diagnose the cause?

It’s of most importance to consult a gynaecologist if this pain occurs every month. In the consultation, the doctor will begin by taking a detailed and directed anamnesis, and of course, a gynaecological examination.

Regarding complementary tests, ultrasound is the main tool to direct the diagnosis, as thanks to it we can diagnose a large part of the anomalies or problems that are related to secondary dysmenorrhea (ovarian cysts, signs that may suggest endometriosis and adenomyosis …).

Magnetic resonance imaging can be useful in some cases, although high-resolution ultrasound is gaining more and more ground than resonance.

What is the treatment?

Since the causes of dysmenorrhea can be different, management must be individualized and adapted to each woman.

• Pharmacological treatment of dysmenorrhea is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen). These drugs inhibit the prostaglandins responsible for the inflammatory process, which is why they are very useful for relieving pain.
• In addition, taking oral contraceptives also produces improvement in symptoms.
• Other types of non-pharmacological measures also seem to be useful to reduce pain. For example, a healthy lifestyle, which includes exercise performed in sessions of approximately 45 to 60 minutes, three times a week or more, regardless of intensity, could provide a clinically significant reduction in the intensity of menstrual pain.
• Diet can be another important factor to take into account, as there’re certain foods that can increase the inflammatory process occurring during the period. It’s advisable to avoid the consumption of ultra-processed, refined sugars, saturated fats, foods rich in salt and in some cases dairy; as well as increasing the consumption of fruits, vegetables and foods rich in fibre.
• When dysmenorrhea is due to an organic cause, the treatment of this cause at its origin may be indicated, sometimes even surgery is necessary to try to reverse the cause provoking it.

Can dysmenorrhea be prevented?

There is no magic formula to prevent dysmenorrhea, but the conjunction of a healthy lifestyle (diet and exercise), as well as taking anti-inflammatories from the day before starting the period can help. The consumption of tobacco and alcohol are also risk factors for this problem.

In any case, it’s always advisable to consult a specialist to assess the origin of dysmenorrhea if it is very severe, to rule out possible associated pathologies and provide a solution.

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Dr Alicia Herencia, a gynaecologist at Instituto Bernabeu.