Period Pain

How common is dysmenorrhoea?

It is estimated that dysmenorrhoea occurs in 50-90% of reproductive age women. It is underreported and therefore it is likely that this is an underestimate. Globally, it causes a significant amount of lost productivity, and is a frequent cause of presenteeism or absenteeism.

What is primary dysmenorrhoea? What are the symptoms?

Primary dysmenorrhoea is due to prostaglandins, which are inflammatory mediators, that are released when the endometrium sheds. They are similar to the hormones released during labour and as such, they cause uterine contractions. When these uterine contractions result in high pressures, the uterus does not receive adequate blood supply, which results in ischemia. Ischaemia stimulates pain nerve fibres leading to pain. It has been shown that that individuals experiencing more pain have higher concentrations of prostaglandins, and increased levels of ischemia, resulting in more intense symptoms compared to those without dysmenorrhoea.

Symptoms typically experienced in those with primary dysmenorrhoea including crampy lower abdominal pain that often starts one or two days before menses and lessens over 1-3 days.  There may be associated nausea, diarrhoea, fatigue, headache or malaise. Primary dysmenorrhoea often improves with age, especially after childbirth.

What causes secondary dysmenorrhoea? 

The most common causes of secondary dysmenorrhoea including endometriosis, adenomyosis, uterine fibroids and pelvic infection. In younger women, a uterine anomaly is important to consider.

What are the treatment options for dysmenorrhoea?

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 inadequate evidence to recommend specific diet or lifestyle changes. 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, 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 adults undertake approximately 150 minutes of moderate intensity exercise per week and additional muscle strengthening exercise at least two times per week.

Heat packs: 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.

Acupuncture: There are some lower-quality studies that suggest acupuncture can be beneficial.

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.

• Non-steroidal anti-inflammatory medications, for example mefanemic acid or ibuprofen. These are taken on your period only and work by reducing the amount of prostaglandins released during your period. They can reduce menstrual pain by approximately 70%.

• Tranexamic acid is most useful in those with painful and heavy periods. It works by helping the blood to clot so there is less flow.

Hormonal medications:

• These medications contain progesterone and/or estrogen. They come in many forms including tablets, injections, vaginal rings, a small implant that is inserted under the skin, and 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 can also be effective at reducing heavy periods, premenstrual symptoms such as bloating, irritability, headaches, and can provide effective contraception.

Each option has benefits, disadvantages, side effects and risks. Mikhaila will discuss these, especially in the context of your health, with you and together we can decide on the best solution.

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 medications are usually required to assist with period pain management post-surgery.

When should I see my Mikhaila?

If you have period pain that is interfering with daily activities, please give us a call to make an appointment with Mikhaila.