Many people are told that painful periods are just part of being a woman, but this is not always true. While mild cramps during menstruation can be normal, severe or life-disrupting pain is a sign that something else may be going on in the body.
While mild menstrual cramps are common, pain that is severe or interferes with daily activities is not considered normal.
Painful menstruation is called dysmenorrhea, a common gynecologic condition characterized by menstrual pain that may interfere with daily functioning. There are two types: primary and secondary. Secondary dysmenorrhea may be caused by underlying medical conditions such as endometriosis, uterine fibroids, adenomyosis, or pelvic inflammatory disease
These conditions can cause heavy bleeding, sharp or burning pain, pain during sex, fatigue, or pain that spreads to the lower back and legs. Research shows that women, particularly Black women are more likely to have their menstrual pain underestimated or dismissed, contributing to delayed diagnosis and treatment. Period pain can have many causes, and while some are mild, others need medical attention.
What is Dysmenorrhea
Dysmenorrhea is defined as painful menstruation, typically involving cramping pain in the lower abdomen that may radiate to the back or thighs.
Appropriate treatment for dysmenorrhea can significantly improve quality of life and reduce disruption to daily activities. There are various treatment options, some of which may be more or less helpful for an individual patient. This activity reviews the evaluation and management of dysmenorrhea or painful menstruation.
It highlights the role of the interprofessional team in evaluating and treating patients with dysmenorrhea, as well as appropriately referring to subspecialty care when indicated.
At Mylurah we’re building a digital platform that centers Black women’s reproductive journeys, including culturally sensitive support for Period, Pregnancy and Postpartum. Because representation in care isn’t optional, it’s essential.
Primary dysmenorrhea
Menstrual pains that recur each time you receive your period but aren’t caused by another illness are called primary dysmenorrhea. One or two days before menstruation or at the onset of bleeding, pain typically begins. You may get mild to severe discomfort in your thighs, back, or lower abdomen. Usually, the discomfort goes away in two or three days. The most prevalent kind of dysmenorrhea is called primary dysmenorrhea.
Secondary dysmenorrhea
Secondary dysmenorrhea occurs when a disorder or infection in your reproductive systems causes painful periods. Compared to regular menstrual cramps, secondary dysmenorrhea pain typically starts earlier in the menstrual cycle and lasts longer. For instance, you could have cramps a few days before to your period, and the discomfort might persist until the bleeding ends entirely. Secondary dysmenorrhea is less common than primary dysmenorrhea but often more severe and persistent.
Is having dysmenorrhea normal?
Pain throughout the menstrual cycle is common. Studies estimate that between 50% and 90% of people who menstruate experience some degree of menstrual pain. This figure is probably greater, though, as medical professionals think that many individuals fail to disclose period discomfort.
Why are period cramps so painful?
What you’re feeling is a tightening and relaxing of your uterus. The muscles in your uterus contract in order to shed your uterine lining.
Pain severity is believed to be related to higher prostaglandin levels, increased uterine contractions, and individual pain sensitivity. There also may not be a clear explanation other than everyone’s body is different.
What are the symptoms of painful menstrual cramps?
- Abdominal discomfort that aches and throbs (perhaps severe).
- You feel pressure in your abdomen.
- Pain in the hips, lower back, and inner thighs.
- Other symptoms include nausea, dizziness, and headaches.
In most cases, the discomfort begins 24 to 48 hours before your period and ends within 48 hours after your period.
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How do I tell the difference between normal cramps and dysmenorrhea?
If you have severe or atypical period cramps, or if they continue longer than three days, see a doctor. Both primary and secondary menstrual cramps are curable, so get evaluated.
First, your doctor will ask you to detail your symptoms and menstrual cycle. A pelvic exam involves inserting gloved fingers into the vagina. During the exam, your physician will introduce a speculum into your vagina. This helps them to obtain a better view of your vagina and cervix.
They may collect a tiny sample of vaginal fluid for testing. The purpose of the examination is to discover whether a medical problem is causing painful periods. If there is no clear cause, your doctor will diagnose you with primary dysmenorrhea.
However, if your doctor suspects you have secondary dysmenorrhea (induced by another medical problem), you may require more testing. Imaging and other diagnostic tests let your doctor get a closer look at your uterus and other reproductive organs. Your provider may recommend:
- Ultrasound: Ultrasound uses sound waves to create images of your uterus, ovaries and other reproductive organs.
- Hysteroscopy: Your provider uses a thin, lighted device to see inside your uterus. The device transmits images of your uterus to a screen.
- Laparoscopy: Your provider makes tiny incisions in your abdomen and then uses a laparoscope (a thin tube with a light and camera at the end) to view your pelvic organs.
If those tests show you have a medical condition causing painful menstruation, your healthcare provider will discuss treatment with you.
WRAP UP
For many women, some cramps are normal and expected around their period. But if your pain is very strong, getting worse, or interfering with daily life, it could be a sign of an underlying issue.
Contact your healthcare provider if you the pain prevent you from doing your normal tasks. Mild cramps are normal. But severe cramping and pain that prevent you from going to school or work may mean you need treatment.
It may be helpful to keep track of your periods and the days on which pain is the worst so you can tell your provider. If you notice other symptoms, like headaches or heavy bleeding, you should keep track of those, too.
