Why Are My Periods So Painful?

I am asked by many of my patients when to bring their daughters in for their first gynecological exam.  Most young girls and teenagers do not need to have an exam until they become sexually active, because with sexual activity comes the risk of STDs (sexually transmitted diseases) and infection with HPV (Human Papilloma Virus) which is the #1 cause of cervical cancer. 

Menstrual cramps and painful periods (called dysmenorrhea), is the main reason moms bring their daughters in to see me before their daughters are sexually active.  It really concerns teenagers and their mothers when periods are so painful.  They wonder if there could be something else wrong causing this to happen.  Some young teenagers even get dizzy and nauseated because the cramps are so bad. 

So what is happening?  The uterus is mostly made up of muscle tissue, and the lining (called the endometrium) builds up every month as your body prepares for implantation of an embryo after fertilization of the egg.  If there is no fertilization and no embryo, then the thickened lining is expelled as a period and the whole process starts all over again the next month.  During menstrual periods, your uterus contracts to help expel the lining.  Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions.  Higher levels of prostaglandins are associated with more severe menstrual cramps.      

It is believed that severe contractions constrict the blood vessels feeding the uterus.  The resulting pain can be compared to the angina (heart pain) that occurs when blocked coronary arteries starve portions of the heart of food and oxygen during a heart attack.  Since we can all understand how painful a heart attack is, then for sure we can imagine the pain this causes every month for those that experience it.

 There are factors that may be associated with more frequent episodes of cramps and dysmenorrhea.  It occurs more frequently in women younger than 20 years old; in those whose puberty starts at an early age (11 or younger); those who experience heavy bleeding during periods (menorrhagia); those who experience irregular menstrual bleeding (metrorrhagia); those who have never delivered a baby; those with family who suffer from dysmenorrhea; and those who smoke.

There are some tests like a CBC (complete blood count), chem panel and hormone tests that can be done to make sure there are no other problems causing the pain - like ovarian cysts, uterine fibroids, cervical polyps, adenomyosis or endometriosis.  Ultrasounds may also be performed.  They are painless and use sound waves to visualize internal organs like the uterus and ovaries. More sophisticated radiological tests can be done if needed like Computerized Tomography (CT), and Magnetic Resonance Imaging (MRI).  Procedures like Hysteroscopy (which is a camera that can be placed into the uterus to check for polyps and fibroids) or Laparoscopy (which is when a camera is placed through the umbilicus to see your uterus and ovaries to check for endometriosis, adhesions/scar tissue and blocked fallopian tubes) may also be performed.

Treatment always depends on the cause of the pain.  Most of the time over-the-counter pain relievers like Midol, Aleve, Aspirin or Motrin are used.  Occasionally, muscle relaxers are used to relax the uterine muscle from cramping.  Birth control pills can also help regulate periods and decrease cramping.

Many women really like to use alternative therapeutic approaches to menstrual cramps and prefer to stay away from medication.  Soaking in a hot bath or using a heating pad on your lower abdomen can be just as effective as over-the-counter pain medication for relieving menstrual cramps.

Also having a regular exercise program has been shown to relieve dysmenorrhea.  Acupuncture is also becoming more accepted and has helped with menstrual cramps.  So does Transcutaneous Electrical Nerve Stimulation (TENS) which is a device that raises the threshold for pain signals and stimulates the release of endorphins - your body's natural painkillers.  Many dietary supplements like vitamin E, omega-3 fatty acids, vitamin B1 (thiamine), vitamin B6 and magnesium supplements may also be effective to reduce menstrual cramps.

We know cramps and painful periods are frustrating and can interfere with school and work.  It is good to know that it is common and there are effective ways of treating them.  So hang in there!