Period pain (menstrual cramps)

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:

• 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 include:

• Irregular periods
• Heavy bleeding during periods
• Vaginal discharge with a foul smell
• Pain during sexual intercourse
• Pain in your back passage (rectum)

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 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 associated with secondary dysmenorrhea include:

• Endometriosis: This condition occurs when the cells that form the lining of the uterus (the endometrium) grow outside the uterus, causing 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), potentially leading to an enlarged uterus, abnormal bleeding, cramping, and pain.
• Pelvic inflammatory disease (PID): A severe inflammatory disorder of the female reproductive organs caused by bacterial infection of the genital tract, such as a sexually transmitted infection.
• Structural differences: Some women are born with structural differences in the size and shape of their wombs that can lead to more painful periods.

Is it normal to have irregular periods? Why do periods change dates every month? If you have concerns about your menstrual cycle and have always wanted to ask these types of questions, you can find answers by watching this video until the end.

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
• Low 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 the menstrual cycle

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

• Blood tests: These tests rule out any infectious processes in the pelvic organs. They may 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 disease tests: This panel of tests determines the presence of sexually transmitted diseases, such as chlamydia and syphilis. For a bacterial 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 images of the internal organs in the lower abdomen, including the pelvic cavity and reproductive system. It helps evaluate unexplained pelvic pain, inflammation, abnormal bleeding, or infection.
• Magnetic resonance imaging (MRI): This test uses large magnets, radiofrequency, and a computer to produce detailed images of internal organs and structures. It is particularly helpful in diagnosing endometriosis and adenomyosis of the uterus.
• Laparoscopy: This procedure is necessary when all non-invasive investigations fail to provide a diagnosis. A thin fiber tube with a lens and light is inserted through an incision in the abdominal wall, relaying 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.

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 dysmenorrhea.
• 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.

Dysmenorrhea can be treated with medicines and, in some cases, with surgery. The treatment depends on the severity and underlying cause of the pain. Here are some 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, which consequently reduces prostaglandin concentration in menstrual fluid, leading to decreased uterine contractility and menstrual volume.
• The most commonly used nonsteroidal anti-inflammatory drugs (NSAIDs) include:
• Diclofenac
• Ibuprofen
• Ketoprofen
• Mefenamic acid
• These drugs are most effective when started before the onset of symptoms and continued for three days. They are usually safe and well tolerated. Side effects may 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 may be combined with them.
• These medicines contain hormones (estrogen and progesterone) that prevent ovulation (the monthly release of an egg) and reduce the release of prostaglandins. This, in turn, provides almost immediate relief from symptoms associated with menstruation, including 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:

• Progestin-only hormones are effective in treating menstrual pain by causing endometrial atrophy and inhibiting ovulation. These methods 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 cases of secondary dysmenorrhea, it is important to identify and treat the root cause of menstrual cramps. Generally, this type of dysmenorrhea is caused by underlying disorders such as endometriosis, fibroids, and adenomyosis.
• For example, to treat endometriosis (where the lining of the endometrium grows outside of the uterus), removal of the endometriotic tissue through surgery can provide significant relief from menstrual cramps.

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. Place a heating pad or a hot water pack over your lower abdominal area. The application of heat improves blood flow to the site and aids in relieving pain. If a heat pack is unavailable, soak a towel in slightly hot water, squeeze out excess water, and apply it to the abdomen. A hot water bottle can also be used.
• Exercise: Exercise helps release endorphins, which are natural pain relievers, and combats pain and cramps during periods. Additionally, exercising increases circulation to the pelvic region and releases hormones that counteract pain-inducing prostaglandins.
• Make Certain Tweaks to Your Diet: Arachidonic acid, a fatty acid, is a precursor in the production of prostaglandins. Consuming a low-fat diet rich in beans, fruits, and vegetables can lower arachidonic acid production. Therefore, adopting a healthy diet may help control dysmenorrhea symptoms.
• Augment Your Diet with Supplements: Vitamin E, omega-3 fatty acids, vitamin B1, vitamin B6, and magnesium supplements have been found effective in relieving pain associated with menstrual cramps.
• Drink More Water: It is a common myth that drinking water during periods increases blood flow. In fact, drinking 6-8 glasses of water helps prevent bloating and manage period pain. Adding lemon or mint to water or consuming water-rich foods like cucumbers and watermelons can also increase hydration.
• Consume Herbal Teas: The following ingredients can be used to make herbal teas to combat period pain:
  • Fenugreek (Methi): Known to relieve menstrual cramps and treat irregular periods. Boil fenugreek in water, strain, and consume as tea or add to meals.
  • Cumin (Jeera seeds): An Indian spice that helps reduce period pain due to its relaxing, antioxidant, antispasmodic, and anti-inflammatory properties.
  • Ginger (Adrak): Known for its anti-inflammatory and analgesic properties, it helps relieve menstrual pain associated with primary dysmenorrhea.
  • Turmeric (Haldi): Curcumin, used in Ayurveda, helps reduce prostaglandin production involved in dysmenorrhea.
  • Apple Cider Vinegar: Contains potassium and calcium that ease muscle cramping during periods. Mix one teaspoon in a glass of water, but use a stainless steel straw to protect teeth.
  • Cinnamon (Dalchini): An Indian spice with antispasmodic properties that reduce menstrual cramps and pain. It also regulates menstrual irregularities and can be consumed with lukewarm water or sprinkled on meals.
  • Chamomile: Rich in antioxidants, it relieves pain from primary dysmenorrhea and improves mood swings. Boil in hot water and strain to consume.

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 that 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 unable 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 result in heavy bleeding during periods, which can 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 receive appropriate medical advice. Here is a list of types of medical experts you can consult.

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
• Marjoram oil

are used for their 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 the insertion of fine needles into specific areas of the body known as acupuncture points. This therapy may help 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 for women not interested in pharmacological management.

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS 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 assist in pain management. A study shows that practicing yoga for 60 minutes once a week may also help to reduce period cramps.

Painful periods can significantly affect daily activities for females. Young girls often miss school, impacting their academic performance, concentration, socialization, and achievement. Dysmenorrhea can also limit women's participation in sports and social events. Additionally, sleep disturbances due to menstrual pain further reduce productivity.

Painful periods are a leading cause of recurrent short-term school absences in adolescent girls and a common issue for women of reproductive age. If you are experiencing symptoms of dysmenorrhea or find it challenging, consider the following tips to ease your menstrual cramps:

• During menstruation, getting adequate rest is essential. Use a heating pad or hot water bottle to alleviate pain. A warm bath can also help reduce overall discomfort.
• Certain foods can help ease cramps, including fruits, vegetables, whole grains, legumes, nuts, and seeds. A healthy diet decreases inflammation in the body and helps manage menstrual cramps.
• Constipation, bloating, and an upset stomach are common issues for women with dysmenorrhea. It is advised to hydrate and include fiber-rich foods to relieve these symptoms.
• A diet rich in vitamin E, omega-3 fatty acids, vitamin B1, vitamin B6, and magnesium has been found to effectively relieve pain associated with menstrual cramps.
• Regular exercise, such as walking, jogging, and stretching, improves blood circulation and helps nutrients and oxygen flow throughout the body. Exercise releases endorphins, which can help block pain.
• Avoid caffeinated drinks and beverages, as they may increase vasoconstriction (the narrowing of blood vessels), potentially worsening cramps during your menstrual cycle.
• Mild and moderate dysmenorrhea usually responds well to NSAIDs.

Menstruation comes with its own share of myths and misconceptions, adding to the confusion surrounding periods. It's time to get period myths busted.