If your periods are heavy and painful, you should know that up to 90 percent of women also feel some painfull sensations in the pelvic area during their periods and you’re not alone. But in some cases, these painful sensations can be quite severe. Teenagers and women in their early 20’s are more likely to have primary dysmenorrhea. Moreover, heavy menstruations are the most common cause of complaints from schoolgirls.
What is Dysmenorrhea?
Dysmenorrhea is a medical term that describes painful menstruation. It is divided into two different types. Primary dysmenorrhea means painful cramps during the period if there are no other pelvic diseases that could lead to pain. Primary dysmenorrhea usually begins within the first year or so after the first menstruation.
Secondary dysmenorrhea means that your painful menstruation was caused by some pelvic diseases like adenomyosis or fibroids. Secondary dysmenorrhea may occur after several years of comparatively mild periods.
Symptoms of Dysmenorrhea
Dysmenorrhea pain usually starts within a day before or after your periods begin and it usually worsens on the day when the blood flow becomes the heaviest. Although some women can experience severe pain for three days or even more.
Women who suffer from primary dysmenorrhea report that the pain is quite predictable and feels the same every menstruation. They often describe it as severe cramping that occurs in the lower abdominal area. These painful sensations can even spread to the lower back and upper hips as persistent or pulsatile discomfort.
Primary dysmenorrhea can be accompanied by other symptoms. They may include:
- Nausea and vomiting
The release of prostaglandins is considered the most likely cause of these symptoms. Prostaglandins are naturally occurring chemicals in your body that lead to the pain of primary dysmenorrhea.
Causes of Primary Dysmenorrhea
The mucous membrane of your uterus is responsible for prostaglandin production. This chemical can cause contraction of the blood vessels and muscles in your uterus. During these contractions of blood vessels and muscles, the blood supply temporarily decreases in the uterus.
This means that you can develop ischemia. Ischemia is usually not prolongated in the uterus and comes in waves with the uterus’ contractions. These changes are very similar to what happens when a heart attack occurs. A decrease in blood flow to the uterus is another cause that leads to the pain of primary dysmenorrhea.
The uterine mucosa produces the greatest amount of prostaglandins before and during the first two days of your menstrual cycle when you have the most severe blood flow. That’s why your symptoms get worse during these days.
When to Visit a Doctor?
The most important thing to know is that you shouldn’t endure and suffer from severe painful sensations during your periods. Some studies show that approximately 20 percent of girls and young women suffer from painful periods. But you shouldn’t miss school, work, or other activities due to painful menstruation. If your periods interfere with your normal activities due to pain and heavy blood flow, it is recommended to consult your doctor about your issues.
Despite the common belief, a pelvic examination is not as bad as it sounds. But if your doctor will be provided with all the needed information, you may not even need to undergo a physical examination to be diagnosed with primary dysmenorrhea. The fact is that you have only a small possibility of undergoing a pelvic exam if you are a teenager and your symptoms are common for primary dysmenorrhea.
If you have already started to be sexually active, your physician will probably recommend you to perform a pelvic examination. It is important because some pelvic infections caused by an STI (such as chlamydia or gonorrhea) could worsen your pain during periods. If your painful sensations don’t decrease even after proper treatment or your doctor determined the root cause, he or she will most likely offer a pelvic examination, even if you are not sexually active.
Your doctor may diagnose you with primary dysmenorrhea without any tests or imaging of the pelvic area. But if your doctor suggests that your pain during periods may be related to some underlying disease, they may recommend you undergo an additional examination.
Treatment Options for Primary Dysmenorrhea
Before looking for the appropriate treatment methods for primary dysmenorrhea, it is important to remember that the amount of the natural chemical called prostaglandins (which are produced in the lining of the uterus) is the main reason for the symptoms of primary dysmenorrhea.
The aim of medical treatment is to decrease prostaglandin production in the mucous membrane of the uterus. There are two main types of medications that are able to do this, hormonal contraceptives and non-steroidal anti-inflammatory drugs (NSAIDs). Hormonal contraceptive medications are able to thin the uterine mucosa and thereby decrease prostaglandin production. The proper use of hormonal contraceptives is considered one of the most effective ways to manage severe menstrual cramps.
There are a few options when it comes to NSAIDs. To stay on the safe side, it is recommended to start with ibuprofen, which is an over-the-counter painkiller. The average effective dose of this medication is 600 mg and it can be taken every 6-8 hours. But in some cases, you may need to take a different or more effective NSAID to block prostaglandin production. But you should be very careful when using NSAIDs because they can harm the stomach mucosa and this can lead to gastritis and stomach ulcers. That’s why you shouldn’t take NSAIDs before a meal on an empty stomach.
Some lifestyle changes can also help decrease pain during your periods. It is proven that regular aerobic exercises have a possibility to reduce pain during menstruations. Dietary changes can be beneficial as well. You may try to eat more foods that are rich in omega-3 fatty acids like walnuts, salmon, and avocados. Foods that contain a lot of vitamin B can also help reduce menstrual cramps. If you follow a balanced diet, you probably get enough vitamin B. But often teenagers don’t follow such a diet, so it would be beneficial for them to take a vitamin B supplements.