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Experiencing Painful Periods?

Learn about primary and secondary dysmenorrhea, and how to relieve the pain during your period

Danielle Wright, MD
Danielle Wright, MD

Dr. Danielle Wright is an Assistant Professor in the Department of OB/GYN at the Uniformed Services University of Health Sciences.

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Experiencing Painful Periods

05 March 2021

Ever feel like 👿🤬😩 when you’re getting your period? 

It can often be easier to laugh off our pain while cursing the period demons, but in all seriousness, period pain is something to address. In fact, 1% of people with periods are unable to do their jobs due to severe menstrual pain (medically known as dysmenorrhea) for one to three days each month, and 14% of young people with periods are absent from education for a day or two each month.

Not only can dysmenorrhea prevent us from doing normal activities at work or school, but it can also affect our sleep and mental health.

For some, pain and cramps can be alleviated with Tylenol or Ibuprofen, while for others, these two therapies are not enough. If period pain becomes debilitating, make sure to consult your doctor to find the best remedy for you. The good news is that dysmenorrhea can be treated, so let’s dive in and learn about the two types of dysmenorrhea.

Hold up, there are 2 types of period pain? 🧐  

Here’s how they’re defined: 

  1. Primary dysmenorrhea = period pain that isn’t due to any diseases you’re just ✨born this way✨ (i.e. you happen to have more chemicals called prostaglandins, which trigger the uterine muscle contractions of menstruation and induce labor when necessary)
  2. Secondary dysmenorrhea = period pain that is due to a disorder in the reproductive system (think: endometriosis, adenomyosis, fibroids - we’ll get to these more in detail later ⏬)

Primary dysmenorrhea

If your regular checkups with your OB/GYN don’t indicate a preexisting condition in your reproductive system but you still experience intense period pain, you most likely have primary dysmenorrhea. Some of the risk factors are early puberty, longer and heavier menstrual flow, higher BMI, or a family history of dysmenorrhea. 

Here are some ways to cope with primary dysmenorrhea: 

💊 NSAIDS

Treat and relieve the pain with scheduled NSAIDs (aka nonsteroidal anti-inflammatory drugs), such as Ibuprofen.

💊💊 Birth control pills

If NSAIDs themselves don’t help, take a birth control pill to help regulate your period.

Bonus: Take a birth control pill continuously (i.e. skipping the placebo week) to help reduce the pain associated with the withdrawal bleed each month

Secondary dysmenorrhea

Secondary dysmenorrhea defines pain that occurs during your period with a known disorder in the reproductive system. For some, it’s comforting to know that you can point a finger to something diagnosable as the cause of your pain. For others, it might seem alarming to know that you have a disorder in your system. But, rest assured as most of these are treatable with early diagnoses! 

Let’s break down some common disorders: 

Different types of secondary dysmenorrhea

Different disorders associated with secondary dysmenorrhea

  • Endometriosis: tissue from lining of uterus is found outside the uterus (where it doesn’t belong), and can bleed in response to the change in hormones
  • Adenomyosis: tissue that normally lines the uterus begins to grow into the muscle wall
  • Pelvic inflammatory disease: infection caused by bacteria that can spread to the reproductive organs
  • Cervical stenosis: the opening of the cervix is too small, preventing menstrual flow and causing a painful increase in pressure
  • Fibroids: non-cancerous growths that form in the wall of the uterus and can cause pain

Depending on what disorder you have, your doctor may ask you to do the following to help treat the pain and diagnose the root cause:

💊 NSAIDS and birth control pills

Like primary dysmenorrhea, most doctors would start you with NSAIDs to relieve pain and birth control pills to regulate your hormones that are contributing to the pain. 

📋 Medical history and physical exam

Your OB/GYN will look into your medical history and conduct a physical exam to see which organ system (gynecologic, urinary, musculoskeletal, gastrointestinal, psychologic, and neurologic) is contributing to pelvic pain. 

🔍 Pelvic exam and ultrasound

You may be asked to take a pelvic exam and ultrasound

Why?: This can help diagnose structural causes of pelvic pain such as ovarian masses and uterine fibroids and can also increase our suspicion for adenomyosis

💉 Laparoscopy

If NSAIDs and birth control don't help to relieve the pain and the ultrasound doesn’t reveal much, you may be asked to do a laparoscopy, a minimally invasive surgical procedure used to examine the inside your abdomen.

Why?: This can help diagnose endometriosis

⅔ of patients are diagnosed with endometriosis after a diagnostic laparoscopy, which is the only way your OB/GYN can diagnose this condition. If you do happen to be diagnosed with endometriosis, your OB/GYN may suggest suppressing your period until pregnancy or menopause to relieve your period pain. You can do this by taking continuous birth control pills, Depo Provera (a birth control shot), or the Mirena IUD. Most people are happy with just doing these steps. 

If you’d like to take it one step further or these solutions aren’t working for you, you can also take Lupron (a hormone injection) and Orilissa (a tablet), both prescribed by your OB/GYN. The most definitive way to treat endometriosis is to undergo hysterectomy, which is the complete removal of the uterus, because no uterus = no uterine tissues in the wrong places. 

The bottom line: 🩸≠😣

Just because there’s blood, doesn’t mean there should be pain.

If you are struggling with painful periods – you’re not alone. Visit your local OB/GYN to see which of these treatments are right for you.

 

SOURCES: 

  1. ACOG.org. 2010. Management of Endometriosis. [online] Available at: <https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2010/07/management-of-endometriosis> [Accessed 15 February 2021].
  2. Hoffman, B. L. (2016). Williams gynecology (Third edition.). New York: McGraw-Hill Education.

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