Menstruation is a normal, physiological, cyclic phenomenon. The regular menstrual cycle is an indication of good hormonal health. These cycles do cause some discomfort. However, as a rule, they must not be painful.
Regretfully, menstrual cycles bring pain for many women, which is not normal. If cycles are painful, it is called dysmenorrhea, and this is pathology. It means that painful menstrual cycles must be treated.
Of course, some pain during the cycles is normal. For example, it is normal to have some discomfort a couple of days before the beginning of the cycle and mild pain for 2-3 days.
In most cases, this pain can be readily managed with the help of commonly available painkillers. But, if the pain is frequent and severe, it is a cause for concern.
Symptoms of period pain
Periods tend to cause pain in the pelvic area, that is, in the lower abdomen. However, the pain is more widespread in many women, affecting even the upper abdomen.
In many cases, pain even radiates to the lower back and legs. In some instances, this pain may be quite severe. For some women, this constant pain during the period is quite debilitating.
Even worse, these pains may cause other symptoms like headaches, sickness, digestive problems, anxiety, worsening of low back pain, exacerbation of irritable bowel syndrome, breast soreness, and significant abdominal pain.
Causes of menstrual pain
It appears that in some women body produces chemicals called prostaglandins in larger-than-normal amounts. These chemicals may cause inflammation, contraction of the uterus, and severe pelvic and abdominal pain. [1]
Production of these chemicals may not only cause abdominal pain. In addition, they make women prone to issues like anxiety, irritable bowel syndrome, mood swings, headaches, migraines, low back pain, and some other health issues.
Therefore, it is vital to visualize menstrual pain in a broader way. Though symptoms like abdominal pain may predominate, such women are at an increased risk of many other health issues.
Higher prostaglandin production makes many women prone to debilitating headaches and mood swings. Hence, it is vital not to neglect these issues.
Should you be worried about it?
Fortunately, most cases of abdominal pain during the menstrual cycle are benign. It means that there is no cause for worry. In most cases, they are readily managed. However, these issues may affect now and then.
In most cases, the body adapts to these things, and most women stop experiencing severe menstrual pains. However, not all are lucky enough; it remains a cause of constant distress for some.
If the pain is severe and keeps repeating every cycle, it is a cause for concern. It means such women should undergo medical tests to exclude some more severe health issues.
Endometriosis: It is a pretty common problem among women who have painful cycles. It mainly causes pain during cycles, as in the condition that cells that normally grow in the uterus may develop in other body areas, like around the ovaries.
Since these cells are sensitive to hormonal changes, they cause pain during periods. It is pretty easy to confuse menstrual pain. Doctors would need to carry out more extensive tests, pelvic examinations, and imaging, like using ultrasound or even MRI, to detect or exclude the condition.
Fibroids: These are non-cancerous tumors in the muscular layer of the uterus. Thus, they might cause significant pain in some during cycles.
Fibroids are pretty common; more than 70% of women might be affected during their lifetime. Doctors may diagnose them through pelvic exams or, more accurately, through ultrasound imaging. [2]
Adenomyosis is another common condition that may affect as many as one-fifth of women. In this condition, tissues that normally line the uterus start growing in the muscular tissues of the uterus, thus causing much pain, particularly during periods. [3]
Therefore, if abdominal pain is severe and occurs during every menstrual cycle, it is vital to identify its cause. If the underlying cause is identified, specific treatment must be provided.
What to do about menstrual pains?
As suggested, first, one should exclude ailments like endometriosis, fibroids, and adenomyosis, requiring specific treatment.
If the above conditions have been excluded, most women will benefit from commonly available painkillers like paracetamol/acetaminophen. However, more severe cases may need NSAIDs, as they are also good for suppressing inflammatory responses. Hence, many women may benefit from medications like ibuprofen.
However, one should also consider non-pharmacological means to control pain, considering that the condition tends to be chronic in most cases. Therefore, one may also use a heat pack to relieve pain and spasm.
Additionally, it is vital to understand that exercise can be of great benefit in many such instances. Physical activity results in the production of endorphins, which can lower pain sensation and even reduce the production of prostaglandins.
Many women may also benefit significantly from contraceptive pills. These pills contain sex hormones and are known to reduce prostaglandin-associated pains. Thus, starting to take contraceptive pills may be a good idea for some women.
There is also a more specific treatment for the condition. An intra-uterine device called Mirena, which releases progesterone into the uterus, is a highly effective treatment for the condition.
In addition, progesterone seems to make periods less heavy and thus may provide significant benefit, especially to those experiencing pain with heavy periods.
Conclusion
In conclusion, while menstruation is a normal process, menstrual pain should not be regular or severe. Persistent pain may indicate underlying health issues such as endometriosis, fibroids, or adenomyosis requiring specific treatment.
Over-the-counter painkillers, non-pharmacological methods like heat packs and exercise, and hormonal contraceptives can help manage menstrual pain. Seeking medical attention is crucial to address the underlying causes and improve overall hormonal health.
References
- Services D of H& H. Menstruation – pain (dysmenorrhoea). Accessed June 4, 2023. http://www.betterhealth.vic.gov.au/health/conditionsandtreatments/menstruation-pain-dysmenorrhoea
- Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. International Journal of Gynecology & Obstetrics. 2020;149(1):3-9. doi:10.1002/ijgo.13102
- Upson K, Missmer SA. Epidemiology of Adenomyosis. Semin Reprod Med. 2020;38(2-03):89-107. doi:10.1055/s-0040-1718920
Dr. Preet Pal SB is a physician (M.D. Medicine) with a specialization in diabetes (Fellowship in diabetes, Royal Liverpool Academy). He has a particular interest in metabolic disorders, considering that they are rising in every corner of the world, more so in India.