Painful Period Cramps (Dysmenorrhea) - Causes and How to Alleviate Pain

I know sometimes the health issues many of you have - that cause so much pain in our bodies - can interfere with summer fun and getting together with your loved ones to relax and enjoy life. Many of you have contacted me or have come to my office concerned because of the pain with your periods.

Some of you have had severe menstrual cramps since your periods first began, and they seem to be getting worse. For the rest of you, you cannot understand why there has been so much change over the years.  Now, your periods are lasting longer and becoming much more painful.  "Wasn't all that supposed to get better, especially after having babies?"  It’s time for a 'Pow Wow' about this topic!  

Dysmenorrhea is the medical term for painful period cramps. There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea. 

Primary dysmenorrhea is named for cramps that begin with the onset of the menstrual cycle.  It's the type of dysmenorrhea that we all remember as teenagers that just got better after a couple years - if we were among the lucky ones.  

Menstrual cramps are caused by contractions in the uterus, which is a muscular organ. The uterine walls are made up of muscle fibers which are wrapped and formed together in layers, with each layer lying slightly differently (horizontal, diagonal, etc.), which allows the uterus to contract powerfully. It is a hollow, pear-shaped organ where a baby grows. It contracts during a woman's menstrual cycle.  But, if the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus.  Pain results when part of a muscle briefly loses its supply of oxygen.  We all experience the same thing when we exercise, run, or do too many sit ups without stopping and begin to feel our muscles cramp up.  These cramps happen for the same reason.   

Secondary dysmenorrhea is caused by some type of abnormality that has developed in the woman's reproductive organs. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.  Often, it is associated with a feeling of pressure in the abdomen, pain in the hips, lower back, and inner thighs.  As cramps become more severe, some women experience upset stomach, sometimes with vomiting and loose stools, and even diarrhea.

For menstrual pain, women can take aspirin or another pain reliever, such as Tylenol (acetaminophen), Motrin (ibuprofen) or Aleve (naproxen).  For best relief, you must take these medications as soon as bleeding or cramping starts. Placing a heating pad or hot water bottle on your lower back or abdomen and taking a warm bath may also provide some relief.  Getting plenty of rest is essential to feeling well mentally and physically.  Diet can also play a part, and some women may need to avoid caffeine and/or alcohol.   And if you smoke, begin a regimen to help yourself to quit. 

There are prescription medications that can be used, such as: birth control pills; prescription strength pain relievers like Motrin 800mg;  many forms of naproxen; and some muscle relaxers.  These may work well with all forms of dysmenorrhea, but if it is secondary dysmenorrhea, it is extremely important to visit your doctor because you may need further testing.  The pain medications or birth control may help relieve symptoms, but could be covering up a more serious problem or infection.

Endometriosis is something else to be aware of.  It is a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus, and can implant on the ovaries, uterus, bladder and has even been found in the lungs of some women with severe disease. 

Here’s another issue to understand.  Pelvic inflammatory disease is an infection caused by bacteria that starts in the uterus and can spread to other reproductive organs.  The bacteria can be from sexually transmitted disease, but often is caused from transfer of bacteria from our own body, or rectal area during intercourse.  Even after the infection is resolved, the remaining damage left from scarring from the previous infection can leave anyone experiencing pain. 

Stenosis (narrowing) of the cervix, the lower part of the uterus, is one form of damage that can be caused from infection or menopause.  If stenosis happens while we are still menstruating it can trap the blood inside the uterus.  This is called hematacolpos and this can cause horrible pain. 

Finally, fibroid tumors (benign growths on the inner wall of the uterus), are another example of what can go wrong that needs evaluation and possible treatment by your doctor.

So it looks like we have a lot of work to do before we can get to the bottom of all this pain and discomfort so you are not controlled by your monthly period.  Please talk to your doctor.