Dysmenorrhea – Painful Periods

Dysmenorrhoea is one of the most common gynaecological conditions that affect the quality of life of many women in their reproductive years. It is a technical term for period pain which literally means ‘difficult monthly flow’.

If you have dysmenorrhea, you are not alone.

Around 80% of women experience period pain at some stage in their lifetime. You can suffer from period pain from your early teens right up to the menopause. In 40% of women, period pain is accompanied by premenstrual symptoms, such as bloating, tender breasts, a swollen stomach, lack of concentration, mood swings, clumsiness and tiredness. Approximately 10–15% of women have severe, disabling dysmenorrhoea, which can contribute to school absenteeism, lost work time, and reduced quality of life.

Period pain happens when the muscles in the uterus contract or tighten. Pain can include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs.

Risk factors for dysmenorrhea include early menarche, null parity and family history. High levels of stress can also greatly increase the incidence of dysmenorrhea, as can depression, anxiety, and disruption of social networks. Dysmenorrhea is a common condition affecting young women. As with other pain conditions the etiology appears to be multifactorial and involves inflammatory mediators, pain pathways and a centralized response.

What is normal period pain? And what is not?

Period pain is only considered ‘normal’ if:

  • The pain is there only on the first one or two days of your period
  • The pain goes away if you take period pain medications or use the contraceptive pill
  • Your ability to do your normal activities is not impaired.


If the pain is not like this, it is not normal.

Depending on the underlying causes, it can be divided into two broad categories :

Primary dysmenorrhea

This commonly occurs in teenage girls and young women, towards the beginning of menstrual life. It happens in the absence of any underlying uterine condition. The cramping pains are caused by the womb contracting to shed its lining. There may also be pain caused by the decreased supply of blood to the womb. The pain is mainly in the lower part of the abdomen but can go into the back and down the front of the thighs.

It is a perfectly natural condition and for many women is simply a mild monthly discomfort. Primary dysmenorrhea can be eased with the contraceptive pill as well as some relaxation techniques.

Secondary dysmenorrhea

This may not start until your mid-twenties or later. It is unlikely to cease after childbirth. The pain is not restricted to “time of the month” bleeding and can occur throughout the cycle. Periods may become heavier and more prolonged, and intercourse may be painful. Secondary dysmenorrhea can be a sign of other conditions, including pelvic infections, which may need urgent attention. Important conditions to worry about include the following:

Fibroid uterus -tumorous growths in the uterus that cause change in shape size and vascularity of the uterus, all of which can lead to painful periods .

Adenomyosisis – condition in which the cells that normally form a lining in the uterus also grow in the muscle wall of the uterus. Endometriosis – condition in which cells similar to those found in the lining of the uterus (endometrium), grow outside the uterus.


Managing with period pain

There are a number of simple ways to ease the discomfort.

  • Relax in a hot bath with aromatherapy oils.
  • A hot water bottle.
  • Back and stomach massage is effective.
  • Gentle exercise such as yoga may help.
  • These techniques help by relaxing the muscles and increasing endorphins which relieve stress and take the pain away.

Lifestyle changes

Research has shown that period pain symptoms can be eased by modifying lifestyle. So try the following:

  • Smoking is thought to increase the incidence of period pain by reducing the supply of oxygen to the pelvic area.
  • Reduce your alcohol consumption.
  • Eat high fibre foods and plenty of salads and vegetables.
  • Daily vitamin E supplements have been shown to help.
  • If you eat red meat make sure it is lean. Eat more chicken and fish.
  • Cut down on sugary foods, chocolate, cakes and biscuits.
  • Reduce the amount of salt in your diet to avoid water retention.
  • Choose pure fruit juices or mineral water rather than sugary drinks.
  • Take a supplement containing gamma linolenic acid (GLA) such as evening primrose oil or starflower oil or vitamin B6. Both help maintain hormonal balance.


If pain persists visit your Gynecologist for a checkup. You might be prescribed specific medication to take care of the pain:

  • Non-hormonal drug treatments: tranexamic acid or mefenamic acid.
  • The contraceptive pill: not only will this reduce some of the pain and discomfort, but will make your periods lighter and more regular.
  • Stronger pain killers:: these should be started as soon as the period starts–don’t wait until the pain is at its worst to take them.
  • The intra-uterine system (IUS) may be suitable for some women: this is a very effective method of contraception which may also reduce blood loss and period pains.

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