Why Do I Have Pain During My Period and What Can I Do About It?


You’re Not Alone!

Painful periods, otherwise known as dysmenorrhea, affect many women across the country and around the world. Dysmenorrhea includes symptoms such as lower abdominal and pelvic pain that may extend to the lower back and/or thighs. While prevalence is higher among adolescents and women in their twenties (approximately 60-70%), some studies estimate that half of all women experience painful periods and cramping.

Why am I having painful periods?

At this point in the menstrual cycle there is a drop in the hormone progesterone, which triggers a cascade of prostaglandins and leukotrienes in the uterus. Prostaglandins and leukotrienes are a normal part of the inflammatory process (ex. when you have a cut, there is some redness and swelling, this is the normal inflammation that helps promote healing), but not always the most pleasant. This inflammation produces menstrual cramps due to muscle contractions and decreased blood flow to the uterus. These prostaglandins also contribute to other menstrual symptoms such as of nausea, vomiting, wheadaches, and diarrhea.  

What can I do about my painful periods?

The good news is that prostaglandins respond to treatment with NSAIDs (Non-steroidal anti-inflammatories) such as ibuprofen (Advil, Motrin) and Naproxen (Aleve). Fun fact: studies have shown decreased prostaglandin levels in menstrual fluid, as well as reduced reported symptoms in women who took routine NSAIDs for their pain. A good recommendation is to begin taking NSAIDs at the onset of (or the day before) the start of the period, and continue taking them on a routine schedule for two to three days.

**It is important to note that while NSAIDs are an over-the-counter product, they are not always safe or the best option for everyone, and it is recommended to check with your medical provider ** 

Combined oral contraceptives (COCs), otherwise known as birth control pills, are a good option for women with dysmenorrhea, especially if preventing pregnancy is also a goal. Typically, periods should become lighter and less painful on COCs, but it is important to know that everyone responds differently. If dysmenorrhea persists, COCs can be taken continuously (skipping the placebo days) which mayalleviate the symptoms by preventing the period altogether. Talk to your provider if you feel that this may benefit you.

Other options include heat therapy, such as a heating pad applied to the abdomen. Many women find that heating pads are just as effective as NSAIDs and more effective than acetaminophen/Tylenol. And while applying a heating pad takes more time than taking medications, it is safe and has no side effects. There are also reports of things such as exercise, yoga, and engaging in sexual intercourse as forms relief from dysmenorrhea.

When should I see my doctor for painful periods?

It is always a good idea to talk to your provider about any questions or concerns you may have. Let your doctor know if your pain persists despite treatment (such as NSAIDs, COCs, heat therapy, etc.). At this time, your provider will take a detailed history of your menstrual cycle as well as perform a physical exam. Based on these findings, further evaluation with ultrasound or bloodwork may be required. There is no definitive test for dysmenorrhea, but it is important to rule out any possible underlying cause.

What are other causes of painful periods that are concerning?

 

If you, or someone you know has these symptoms feel free to come in and talk to one of our providers so that we can develop a personalized treatment plan for you. Always remember, the OBGYN office is a safe place to ask questions, even if you think something is normal feel free to ask us about it!


Author
Sarah Wilson, ARNP “Personalized care for women of all ages.”

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