Dr. Dimple Doshi (MBBS, MD, DGO)
Lady Gynecologist & Laparoscopic Surgeon
27+ years’ experience
20,000+ surgeries completed
More than half of the women have some pain during menses for 1 or 2 days; and usually the pain is mild. But for some women it is so severe that it prevents them from doing their normal activities.
Pain; in severe cases may be associated with diarrhea; nausea; vomiting; headache or dizziness.
There are two types of dysmenorrhea:
It is the cramping pain that happens before or during period.
Primary dysmenorrhea can begin soon after a girl starts having menstrual periods.
In many women with primary dysmenorrhea, periods become less painful as they get older. This type of period pain may also improve after giving birth
That is how if you are suffering from dysmenorrhea; you must have got this advice from your doctor that it will end as you grow.
It is the pain that is caused by disorders of the reproductive tract.
The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. For example, the pain may begin a few days before a period starts. The pain may get worse as the period continues and may not go away after the period ends.
It is caused by natural chemicals made by the uterus; called prostaglandins which cause the muscles and blood vessels of the uterus to contract. On the first day of the period; the level of prostaglandins is high; so the pain is maximum; and then it lessens after the first few days of the period.
Some of the conditions that can cause secondary dysmenorrhea include the following:
Endometriosis happens when tissue similar to the lining of the uterus grows in other areas of the body, such as on the ovaries and fallopian tubes, behind the uterus, and on the bladder. Like the lining of the uterus, this tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially around the time of a period. Scar tissue called adhesions may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, also causing pain.
Fibroids are growths that form on the outside, on the inside, or in the walls of the uterus. Fibroids located in the wall of the uterus can cause pain. Small fibroids usually do not cause pain.
Adenomyosis develops when tissue that normally lines the uterus begins to grow in the muscle wall of the uterus. This condition is more common in older women who have had children.
Certain defects or the abnormalities in the shape and size of uterus that a woman is born with can result in pain during menstruation.
Some medical conditions can flare up during a period and cause pain. These conditions include Crohn’s disease and urinary disorders.
Yes, if you have painful periods requiring pain killers; you must see your gynecologist who will assess your pain. Your gynecologist may use Visual analog pain scale to assess the severity of your pain:
The visual analog scale (VAS) is
You will be asked to indicate your perceived pain intensity along a 10 cm horizontal line, and this rating is then measured from the left edge (=VAS score).
If needed, your ob-gyn may recommend a pelvic exam. A first step in treatment may be medications. If medications do not relieve your pain, treatment should focus on finding the cause of your pain.
Primary dysmenorrhea requires no specific treatment; and you need not worry much as you will stop getting the pain as you age and the severity of pain may become less.
Secondary dysmenorrhea must be addressed as early as possible to prevent any long term consequences .
1. Careful history taking by your gynecologist and detecting anything abnormal.
2. Physical examination by your gynecologist
3. Ultrasonography to assess the cause of pain like fibroid; chocolate cyst or adenomyosis
4. Laparoscopy is often done to view the organs in the pelvis to diagnosis endometriosis as the cause of pain. Laparoscopy is a procedure in which a thin lighted telescope with camera is inserted through a tiny incision on the abdomen and all the organs are visually inspected for any abnormalities.
1. If the cause of dysmenorrhea is chocolate cyst or endometriosis; laparoscopy is advised to excise the chocolate cysts and ablation and removal of tissues having endometriosis
2. If a uterine fibroid(s) is causing pain; surgical option is either myomectomy which may be performed by laparoscopy or hysterectomy if necessary
3. If adenomyosis is the cause of pain; either adenomyosis excision which may be done laparoscopically
4. Hysterectomy is done if severe pain associated with bleeding is present and if the child bearing is completed with no further desire of fertility in extreme cases having fibroids; severe endometriosis or adenomyosis
Dysmenorrhea refers to pain associated with menstruation. Relevant ICD-10 codes are:
Diagnosis and management of dysmenorrhea may involve several procedures:
Ans Dysmenorrhea refers to painful periods that are stronger than mild routine cramps. When menstrual pain affects daily life, needs medicines often, or becomes severe, it is considered more than normal cramping.
Ans Common symptoms of dysmenorrhea include lower abdominal cramps, pelvic pain, lower back pain, thigh pain, nausea, vomiting, loose motions, headache, tiredness, and pain that starts before or during periods.
Ans Primary dysmenorrhea is period pain that occurs without any underlying pelvic disease. It is usually caused by natural uterine contractions during menstruation and often begins during teenage years.
Ans Secondary dysmenorrhea is painful menstruation caused by an underlying gynecological condition such as endometriosis, fibroids, adenomyosis, pelvic infection, or ovarian cysts.
Ans Primary dysmenorrhea usually starts during adolescence, often within a few years after the first period. Dysmenorrhea that starts later in adulthood may need evaluation for secondary causes.
Ans Dysmenorrhea usually lasts for 1 to 3 days during menstruation. Pain is commonly strongest on the first or second day of the period and gradually reduces as bleeding continues.
Ans Dysmenorrhea pain may begin before bleeding because hormonal changes and uterine contractions can start before menstrual flow appears. This may cause cramps a few hours or a day before periods.
Ans Dysmenorrhea can cause lower back pain because uterine contractions and pelvic nerve pathways can radiate pain from the lower abdomen to the back, hips, or thighs.
Ans Yes, dysmenorrhea can cause nausea, vomiting, loose motions, headache, or dizziness in some women. These symptoms are commonly related to prostaglandins released during menstruation.
Ans Yes, secondary dysmenorrhea can be caused by endometriosis. This is more likely if period pain is severe, worsening over time, or associated with pain during intercourse or difficulty conceiving.
Ans Yes, fibroids can cause secondary dysmenorrhea, especially when they are associated with heavy bleeding, pelvic pressure, prolonged periods, clots, or lower abdominal discomfort.
Ans Yes, adenomyosis can cause secondary dysmenorrhea. It may lead to painful periods, heavy bleeding, pelvic heaviness, and worsening menstrual pain, especially in women above 30 years.
Ans Primary dysmenorrhea usually does not affect fertility. However, secondary dysmenorrhea due to endometriosis, fibroids, adenomyosis, or pelvic infection may sometimes be linked with fertility concerns.
Ans Yes, many women with dysmenorrhea can get pregnant naturally. If dysmenorrhea is severe, worsening, or associated with irregular bleeding or difficulty conceiving, gynecological evaluation is recommended.
Ans Dysmenorrhea is diagnosed through menstrual history, symptom assessment, pelvic examination when needed, and ultrasound or further tests if secondary dysmenorrhea is suspected.
Ans The best treatment for dysmenorrhea depends on the cause and severity. It may include pain-relief medicines, heat therapy, lifestyle measures, hormonal treatment, or treatment of underlying conditions.
Ans Mild dysmenorrhea may improve with heat therapy, gentle exercise, yoga, hydration, adequate sleep, and stress control. However, severe or recurring dysmenorrhea should be medically evaluated.
Ans You should see a gynecologist if dysmenorrhea is severe, starts suddenly, worsens over time, lasts more than 3 days, occurs with heavy bleeding, or affects daily activities.
Ans Dysmenorrhea can often be managed effectively. Permanent relief depends on the cause. Primary dysmenorrhea may improve with age or treatment, while secondary dysmenorrhea needs treatment of the underlying condition.
