Painful Menstrual Periods
(Dysmenorrhea; Menstrual Cramps)
DefinitionPainful menstrual periods, also called dysmenorrhea, may include pain in the pelvis, abdomen, back, or legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their lives. In some women, the pain is severe enough to interfere with normal activities.There are two types of dysmenorrhea:
- Primary—painful regular menstrual cycles caused by uterine muscle contractions
- Secondary—painful periods due to an underlying condition, such as endometriosis
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CausesPrimary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.Secondary dysmenorrhea can be caused by:
- Ovarian cysts
- Infection of the female reproductive organs— pelvic inflammatory disease
- Noncancerous growths in the uterus— uterine fibroids
- Intrauterine device (IUDs)
- Scars inside the abdomen from previous surgery
- Inflammatory bowel disease
Risk FactorsPainful menstrual periods are more common in women under age 30 years. Other factors that may increase your risk of having painful menstrual periods include:
- Low body weight, especially during adolescence
- Early onset of menstruation—younger than 12 years old
- Longer menstrual cycles
- Heavy bleeding during periods
- Never having delivered a baby
- Psychological disorders, such as depression or anxiety
SymptomsThe pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing, or dull and aching. It is most typically located in the lower abdomen and may spread to the low back or thighs. Other symptoms may include:
When Should I Call My Doctor?Call your doctor if you have:
- Severe or unusual cramps
- Cramps that last for more than a few days
- Signs of infection, such as fever or chills
- Cramps with heavy menstrual bleeding
- Abdominal or pelvic tenderness
- Vaginal discharge other than menstrual bleeding
DiagnosisYour doctor will ask detailed questions about your symptoms and medical history. A pelvic exam will be done.Specific tests can evaluate your pelvic organs and surrounding structures. Tests may include:
TreatmentPrimary dysmenorrhea is usually treated with medications and lifestyle changes.The treatment of secondary dysmenorrhea varies depending on the underlying condition.
MedicationsOver-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line treatment for menstrual pain. Examples of these medications include ibuprofen and naproxen.Birth control pills may be prescribed in some cases.
Other TreatmentsOther ways to ease discomfort include:
- Heat therapy, which may include heating pads, warm baths, or continuous low-level heat patches
- Regular exercise
- Alternative treatments, such as:
PreventionTo help reduce your chance of painful menstrual periods:
- Exercise regularly
- If you smoke, talk to your doctor about how you can quit
- Drink only moderate amounts of caffeine and alcohol
American Congress of Obstetricians and Gynecologists
Family Doctor—American Academy of Family Physicians
Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
Coco AS. Primary dysmenorrhea. Am Fam Physician. 1999;60:489-496.
Dysmenorrhea. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/dysmenorrhea/hic%5Fdysmenorrhea.aspx. Accessed August 25, 2014.
Dysmenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 6, 2014. Accessed August 25, 2014.
Menstrual cycle problems. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/menstrual-cycle-problems.html. Accessed August 25, 2014.
Dysmenorrhea: symptoms. American Academy of Family Physicians' Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/dysmenorrhea.html. Updated April 2014. Accessed August 25, 2014.
French L. Dysmenorrhea. Am Fam Physician. 2005;71:285-291. Available at: http://www.aafp.org/afp/2005/0115/p285.html. Accessed August 25, 2014.
Pelvic inflammatory disease (PID): CDC fact sheet. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/std/pid/stdfact-pid.htm. Updated July 1, 2014. Accessed August 25, 2014.
9/30/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Witt CM, Reinhold T, Brinkhaus B, et al. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008;198:166.e1-8.
4/15/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014;89(5):341-346.
6/18/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhea: a systematic review. J Physiother. 2014;60(1):13-21.
- Reviewer: Andrea Chisholm, MD
- Review Date: 08/2014
- Update Date: 06/18/2014
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