Your guide to understanding dysmenorrhea

The medical name for pain felt during menstruation is dysmenorrhea, with the most common symptom being menstrual cramps. But while mild period pain is very common and a normal part of a woman’s menstrual cycle, for some women the pain is much more extreme and has a severe impact on their life. We take a look at the causes, symptoms and treatments for severe menstrual pain.

What is dysmenorrhea?

Dysmenorrhea (sometimes spelled dysmenorrhoea) is the medical term for menstrual cramps — pain before and during your period. Menstrual cramps are felt as painful muscle cramps in the abdomen, although the pain can spread to the lower back and upper thighs. The pain can vary from intense spasms to a dull constant ache. It can be so severe that you may have to take time off work or school.

Dysmenorrhea can also vary between periods. And sometimes you may get pain even when you are not having your period. The majority of women who menstruate will experience some pain during their period.

What causes dysmenorrhea?

In healthy women, very mild contractions occur in the womb (uterus) all the time. These contractions are normally so mild that you normally don’t notice them. During menstruation, the muscular wall of the womb starts to contract more vigorously.

These contractions enable the womb lining to shed as part of your monthly period. Each contraction compresses the blood vessels that line your womb, temporarily cutting off the blood supply.

By cutting the blood supply, the amount of oxygen that reaches your womb is reduced. This lack of oxygen in the womb causes it release some chemicals that can trigger pain. This pain then causes the womb muscles to contract more, which increases the level of pain.

Pain that is caused during a normal menstrual cycle is sometimes called primary dysmenorrhea. In some circumstances, intense period pain can be caused by an underlying medical condition, such as:

• Endometriosis: the tissue that lines the womb starts to grow outside of it, such as in the fallopian tubes.
• Uterine fibroids: these are non-cancerous growths in and around the womb. Pelvic inflammatory disease: bacteria can cause the womb to become inflamed.
• Adenomyosis: tissue that lines the womb starts to grow in the womb’s muscular wall.

Menstrual pain from an underlying medical condition is sometimes called secondary dysmenorrhea and it can signify a problem with the reproductive organs. If period pain is caused by a medical condition then this may affect your fertility. You should seek medical advice from a doctor if you are concerned about your fertility and are trying to become pregnant.

In some circumstances, dysmenorrhea can also be caused by contraceptive devices, such as the intrauterine device (IUD). This contraceptive device fits inside the womb and is made from copper and plastic.

What are the symptoms of dysmenorrhea?

Dysmenorrhea symptoms often start a few days before your period with a dull ache in your lower abdomen. The symptoms normally peak after the onset of your period and subside a few days later. Symptoms can vary wildly from woman to woman, but the most common symptoms include:

• Cramping in the lower abdomen
• Pain in the abdomen, which can radiate to the lower back and legs
• Nausea or vomiting
• Loose stools
• Headaches
• Tiredness or fatigue
• Bloating

Menstrual pain from an underlying medical condition is sometimes called secondary dysmenorrhea and it can signify a problem with the reproductive organs. Symptoms include:

• Irregular or heavy periods 
• Bleeding between periods
• Unusual discharge from your vagina
• Sexual intercourse may be painful, and you may bleed afterwards

If you have any of these symptoms, then you should seek medical advice from your doctor. These symptoms may be caused by problems other than painful periods, such endometriosis or adenomyosis.

How do you diagnose dysmenorrhea?

Menstrual cramps are a part of a normal menstrual cycle. However, you should seek medical advice if you have severe period pain or your periods become irregular or heavy.

You doctor will look at your medical history and perform a pelvic examination. This is to rule out other causes of your pelvic pain, such as an infection. They may refer you to a specialist, such as a gynaecologist, for further tests. These include:

• Urine or blood test: These are to test for hormone levels or an infection
• Ultrasound scan: A transvaginal ultrasound scan can help identify any abnormalities with your reproductive organs
• Laparoscopy: This is a surgical procedure that allows the surgeon to look inside your body using an instrument called a laparoscope
• Hysteroscopy: A hysteroscopy uses a small telescope, called a hysteroscope, to look inside your womb. It is inserted through the vagina and cervix

Any treatment options will depend on whether your pain is caused by an underlying medical condition, such as antibiotics to treat a bacterial infection.

Self-help for dysmenorrhea

There are many home treatments for menstrual cramps that you can try to ease mild period pain.

Over-the-counter pain medication, such as aspirin and ibuprofen, can help manage the pain associated with dysmenorrhea. Other treatments include:

• Exercise: Being active may reduce pain. Women who exercise regularly often experience less menstrual pain
• Apply heat: Placing a hot water bottle or heating pad on your lower abdomen may help reduce pain
• Warm bath: This can help you to relax as well as relieve pain
• Massage: A light massaging of your lower abdomen or lower back may help reduce pain
• Transcutaneous electrical nerve stimulation (TENS) machine: This is a small, battery-operated device that sends mild electrical signals to your skin. It may help reduce pain. TENS machines can be bought from your local pharmacy
• Avoid or stop smoking: Tobacco is believed to aggravate period pain symptoms

What are dysmenorrhea treatments?

In most cases, dysmenorrhea pain can be treated at home. However, if your symptoms are particularly severe, your doctor might recommend a medical treatment.

A hormonal contraceptive may be prescribed. This can be in the form of a pill (commonly called the birth control pill or contraceptive pill), an implant, injection or skin patch. These hormones prevent ovulation and reduce the severity of menstrual cramps.

If your dysmenorrhea is caused by a medical disorder, such as endometriosis, then surgery may be an option. The treatment options will depend on the medical condition that has been diagnosed.

In very rare circumstances a hysterectomy may be an option if the pain is severe. This is a surgical procedure to remove the womb. It is only offered to women who no longer want to have children.

Get help for dysmenorrhea

A consultation with an experienced gynaecologist is often the quickest and simplest way to resolve your problem. They will be able to diagnose the cause of your pain and talk with you about the best treatment options for your specific situation.

To book an initial consultation with one of our specialists, call us directly or use our online booking system to find a gynaecologist near you. 

If you would like to know more about dysmenorrhea, download our Women's Health Matters report.