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!

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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.

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