Painful Periods: Information for Young People
Painful periods, also known as dysmenorrhoea, describes pain with period. Whilst some degree of pain during your period is normal, excessive pain that prevents you from doing normal activities (including going to school or catching up with friends), is considered abnormal.
How common are painful periods?
The exact prevalence of painful periods in adolescents is hard to know as lots of young people don’t ever tell their doctor they have pain with periods. It is estimated that up to nine in ten adolescents and young people have painful periods, with one in eight having severe pain that requires days of school or work each month.
What causes period pain and why does it occur?
Period pain is usually felt as cramps in the lower abdomen. These cramps are caused when the uterus contracts, that is when it tightens and relaxes continuously. The chemicals responsible for these cramps are called prostaglandins. Prostaglandins can also cause nausea, vomiting, diarrhoea and light-headedness, which often people may experience prior to their period. It is not exactly known why some people experience more period pain than others, however it is thought that higher concentrations of prostaglandins may be produced in those experiencing more pain. Prostaglandin related period pain is called ‘primary dysmenorrhoea.’
Is there anything else that could be causing my pain?
In around one in ten young people, painful periods are due to causes other than prostaglandins. The most common include conditions that obstruct the flow of menstrual blood and endometriosis (see below). These causes are called ‘secondary dysmenorrhoea.’
What tests do I need if I have painful periods?
Mikhaila will take a careful history and examination. This is usually enough to diagnose dysmenorrhoea. A pelvic ultrasound may be required particularly if you pain is not controlled despite trialling medication.
How can I manage painful periods?
There are several options for managing period pain. The choice of management depends on several factors including how troublesome your pain is for you and how much it interferes with daily activities. Mikhaila will discuss the benefits and disadvantages of each option for you to help decide on the best choice for you.
Lifestyle changes:
A healthy balanced lifestyle is useful for your general health, and also for reducing pain. There is limited evidence to recommend specific diet changes or lifestyle changes to best reduce your pain. I recommend having a well-balanced and nutritious diet, regular exercise, regular stress reduction and ensuring you get adequate sleep. There is limited evidence to suggest supplements and food extracts, such as fenugreek, ginger, valerian, zataria, zinc sulphate, fish oil and vitamin B1, may provide potential benefit.
Exercise is important for reducing period pain and can also improve psychological wellbeing. It is not known what type of exercise is best for reducing pain. For general health, it is recommended that adolescents undertake at least 60 minutes of moderate intensity exercise per day and muscle strengthening exercise at least three times per week.
Application of heat to the lower stomach is effective in reducing pain due to your period and may improve the effectiveness of other treatments. This may include a warm shower or bath or a heat pack.
There is some small studies that suggest acupuncture may be beneficial in reducing period pain.
Medications
There are two types of medication that can be used for improving painful periods. These include non-hormonal medication and hormonal medications.
Non hormonal medications. These tablets can be used for many conditions, including painful periods. The tablets are taken when you are having your period, rather than every day of the month. They include non-steroidal anti-inflammatory medications, which reduce the amount of prostaglandins released during your period, and tranexamic acid, which helps the blood to clot. Overall, they reduce menstrual pain by up to 90%. Tranexamic acid is most useful in those with painful and heavy periods.
Hormonal medications: These medications contain progesterone and/or estrogen. They come in many forms including tablets, injections, a small implant that is inserted under the skin, and an intrauterine device that is inserted into the uterus. If you choose hormonal tablets, you must take a tablet every day of the month, rather than just when your period occurs. They are associated with up to 100% reduction in period pain depending on which medication you use. They can also be effective at reducing heavy periods, premenstrual symptoms such as bloating, irritability, headaches, and can provide effective contraception.
Surgery
A laparoscopy, which is keyhole surgery where we use a camera to look into your abdomen, may be required if your pain is interfering with your daily activities despite an adequate trial of medical treatment. A laparoscopy can diagnose and treat endometriosis (see below). Regardless of whether endometriosis is found on laparoscopy, it is important to discuss medications to reduce period pain post laparoscopy as a laparoscopy may not improve your pain, and if endometriosis is identified, medication is required to reduce the risk of recurrence.
What is endometriosis and could I have it?
Endometriosis is a condition when the lining of the uterus, the endometrium, is found outside the uterus. The endometrium, regardless of where it is located, responses to your monthly hormonal fluctuations. During your period, the endometrium sheds, however if this tissue is outside your uterus, the ‘shedding’ process occurs inside your abdomen and can contribute to your pain. People with endometriosis can have variable symptoms, ranging from no period pain (that is when endometriosis detected for other reasons) to severe period pain. A detailed pelvic ultrasound can give some indication of whether severe endometriosis is present however at present the only definite way of knowing if you have endometriosis is by doing surgery. Given surgery has risks, it is recommended that medication is tried initially, and if your pain improves, you may not require surgery. However, if you have severe period pain that is not improving with medication, it is important to discuss the benefits and risks of surgery with Mikhaila.
When should I see Mikhaila?
If you have significant period that is preventing you from going to school or catching up with your friends, please contact your GP or give us a call to make an appointment.
Melbourne Gynaecological Care
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