Painful Periods: Causes, Diagnosis, and Strategies for Relief

Dysmenorrhea. Even the word looks painful. What is it? The medical term for the painful cramps associated with menstruation. And since more than half of people who menstruate will experience dysmenorrhea, and sometimes severe enough to disrupt routine activities of daily life for a few days per month, it’s a topic worth a deeper dive. This discussion will explore the various aspects of period cramps, including causes (sometimes dysmenorrhea has a secondary cause, like endometriosis or uterine fibroids), diagnostic methods, management tips, and treatments.

What causes period cramps?

Most cases of period cramps are primarily caused by prostaglandins, hormone-like substances that control things like inflammation, pain, blood flow, and labor induction. During menstruation, prostaglandins build up in the lining of the uterus, which triggers pain, decreases blood flow and oxygen to the uterus, and causes the uterine muscles to contract in order to expel its thickened lining. Prostaglandins might also contribute to other menstrual symptoms such as nausea and diarrhea. Generally speaking, more prostaglandins = more severe period cramps. That’s why period cramps are usually worse at the beginning of your period – levels of prostaglandins decrease as you shed lining and bleed. The good news? Primary dysmenorrhea tends to become less painful on its own with age and often improves after giving birth.

On the other hand, secondary dysmenorrhea is caused by a disorder with the reproductive organs, and this period pain often gets worse over time and lasts longer than ‘normal’ menstrual cramps. For example, these cramps might start a few days before a period starts, might get worse as it continues, or might not go away when it ends.

Secondary dysmenorrhea has several possible causes:

• Endometriosis – Endometriosis occurs when tissue similar to the lining of the uterus grows in other areas of the body, like on the ovaries and fallopian tubes, behind the uterus, or on the bladder. Like the uterus, this tissue also builds up, breaks down, and bleeds in reaction to hormone changes. This bleeding can cause period pain and, over time, it can cause adhesions to form inside the pelvis. And, as you might guess, adhesions can stick together and cause pain as well.
• Uterine Fibroids – Fibroids are noncancerous growths that form on the inside, on the outside, or in the walls of the uterus. Small fibroids usually don’t cause pain, but fibroids located in the walls of the uterus can be trouble makers.
• Adenomyosis – Adenomyosis, which is more common in older people who have had children, develops when tissue that normally lines the uterus grows into the muscle wall of the uterus. Ouch.
• Pelvic Inflammatory Disease – PID is an infection in the reproductive organs that originates as a sexually transmitted infection (STI) that goes untreated.
• Cervical Stenosis – In some people, the opening of the cervix is small enough to hinder menstrual blood flow, which can cause pressure to increase within the uterus. And increased pressure causes pain.
• Other Conditions – Some medical illnesses, like Crohn’s Disease and urinary disorders, can flare during menstruation and cause pain.

How do doctors diagnose and treat period cramps?

Diagnosis

Often, your provider can diagnose dysmenorrhea by reviewing your medical history, performing a physical and pelvic exam, and using clinical experience and intuition. But, in some instances, your provider might recommend further testing, such as:

• Ultrasound – This test uses harmless sound waves to create images of your pelvic organs and is the quickest and easiest way to get a first look at the uterus, fallopian tubes, and ovaries.
• CT or MRI – These scans provide much greater detail than ultrasound and can help your provider diagnose any underlying cause(s) of secondary dysmenorrhea.
• Laparoscopy – In more extreme cases, your provider might recommend an outpatient surgical procedure to get a better look at your abdominal cavity and reproductive organs. Laparoscopy, which entails making small incisions in the belly and inserting a thin camera, is the gold standard for diagnosing (and often treating) endometriosis, adhesions, fibroids, ovarian cysts, and other possible causes of secondary dysmenorrhea.

Treatment

Treatment for period cramps usually begins with NSAIDS (nonsteroidal anti-inflammatory drugs), like ibuprofen (Advil, Motrin) and naproxen (Aleve). What’s cool is that these pain relievers actually reduce the prostaglandins produced by the body and lessen their impact on inflammation and pain. Because fewer prostaglandins means fewer symptoms, NSAIDs are most effective when started the day before you expect a period to start and continued for several days afterward.

Birth control methods, like the pill, the patch, the vaginal ring, injections, implants, and IUDs can also be useful in treating painful periods. These medications thin out the lining of the uterus, where prostaglandins are formed, which decreases uterine contractions and menstrual bleeding. Many people solve the dysmenorrhea dilemma within months after starting birth control.

If painful cramps are being caused by a secondary source, like endometriosis or fibroids, surgery might reduce symptoms. Most likely, you will undergo a laparoscopy, which is a minimally invasive outpatient surgery.

Another possible treatment for fibroids and adenomyosis (and the secondary dysmenorrhea they cause) is uterine artery embolization, a procedure that cuts off blood supply to those growths. The indications for UAE are similar to those for surgery – significant fibroids or menstrual symptoms uncontrolled by other medical or less invasive treatments.

If endometriosis is the most likely cause of period pain, your provider might recommend a medication that works on the gonadotropin-releasing hormone (GnRH). A well-studied treatment option, GnRH drugs have proven effective in reducing endometriosis-associated symptoms. But some of them come with potentially serious side effects, which you will need to discuss with your provider.

Managing period cramps with self-care and alternative treatments

There are many self-care practices and lifestyle modifications that can vastly improve period symptoms and, well, life in general. Here are a few:

• Exercise – Physical activity (talk to your doctor first!), including sex, produces chemicals that block pain, improves blood flow, and reduces inflammation.
• Heat – Taking a hot bath or using a heating pad/patch on your lower abdomen (or wherever your period pain pops up) might help ease period cramps.
• Sleep – What does more regular, more restful sleep NOT help?
• Rest, relax and reduce stress – Meditation, mindfulness, and yoga practices can help cope with pain.
• Dietary supplements – Some studies have shown that vitamin E, omega-3 fatty acids, vitamin B-1, vitamin B-6, and magnesium might reduce menstrual cramps. But not enough research has been conducted to recommend these elixirs without speaking to your provider first.
• Alternative or complementary treatments like acupuncture, acupressure, and transcutaneous electrical nerve stimulation (TENS) might be useful for painful periods. Most alternative therapies haven’t been studied enough for experts to fully recommend them, however studies to indicate acupuncture is valuable and can be quite effective at curtailing period cramps.
• Physical therapy that eases trigger points and includes relaxation exercises, like biofeedback, may ease pain symptoms.
• Acupuncture can alleviate pain from period cramps by stimulating endorphin release, improving blood flow, and potentially regulating hormonal balance. At Tia, our providers typically recommend acupuncture when experiencing painful period cramps, which we offer in our clinics! You can sign up for a Tia membership to check appointment availablility at the clinic nearest you.

Win the fight against painful period cramps

While primary dysmenorrhea is typically related to the natural menstrual cycle (prostaglandins) and managed with medication and lifestyle adjustments, secondary dysmenorrhea requires thorough evaluation and treatment of underlying health issues. If you are experiencing severe, persistent, and debilitating menstrual pain, consult your healthcare provider to get a comprehensive assessment and tailored treatment plan. With the right management, you can find some relief from period cramps, which always improves your quality of life!