Dysmenorrhea. Causes and ways of treatment

In short: Period pain is caused by substances called prostaglandins that make the uterus contract. It is of two kinds: primary, a normal effect of hormonal changes, and secondary, due to a condition such as endometriosis, fibroids or ovarian cysts. Pain is treated with painkillers, hormonal pills or the hormonal IUD, and the cause is treated surgically when needed; it often eases with age and after pregnancy and childbirth.

What are the causes of menstrual pain?

Hormonal changes in the body after ovulation, which lead to the release of substances called prostaglandins, which are responsible for causing contractions in the uterus. During contractions in the uterine muscles, there is a momentary decrease in blood flow, which causes pain

Does menstrual pain indicate ovulation?

Not exactly. Primary menstrual pain is typical of cycles in which ovulation has occurred, and cycles without ovulation are usually less painful. However, pain is not a reliable test of ovulation, because pain caused by conditions such as endometriosis or adenomyosis can occur in any cycle.

Is menstrual pain severe?

Not necessarily, menstrual pain ranges from bearable and responds to simple painkillers to severe and requires intramuscular or intravenous painkillers.

What is the classification of menstrual pain?

• Primary: Due to prostaglandins that are secreted physiologically
• Secondary: Due to diseases in the female reproductive system such as:
• Endometriosis
• Uterine fibroids
• Ovarian cysts
• Adenomyosis (lining tissue of the uterus growing into the uterine muscle wall)
• Pelvic vascular congestion
• Severe pelvic infections

How can menstrual pain be relieved?

• Using anti-inflammatory painkillers (NSAIDs such as ibuprofen, mefenamic acid or naproxen), which block prostaglandins and are the first-line treatment; they work best when started at the first sign of the period or pain. Injections are rarely needed
• Using hormonal pills (such as birth control pills) that reduce the production of prostaglandins that cause menstrual pain
• Using a hormonal IUD
• Treating the secondary cause such as:
• Fibroid removal
• Cauterization or removal of endometriosis
• Treating infections
• Using treatments to relieve pelvic congestion and sometimes performing a catheterization of the blood vessels in the pelvis
• Removal of ovarian cysts

If period pain does not improve after 3–6 months of anti-inflammatory painkillers and/or hormonal treatment, or if it is accompanied by pain during intercourse, pain between periods, heavy or irregular bleeding or difficulty conceiving, you should be examined to look for a secondary cause such as endometriosis.

Does menstrual pain decrease with age?

Yes in some cases, and in other cases it may increase

Does menstrual pain decrease with pregnancy and childbirth?

Yes in some cases

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist