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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Article Home Women's Health Painful menstruation

Painful menstruation

It is also known as dysmenorrhea. Some women have the problem of crampy abdominal pain or sharp pain or lower back pain just before the start of the periods or during the periods. This can affect their daily physical activities and make them bed ridden. It generally subsides as menstrual bleeding tapers off and for few it is definitely is a loss of work.

It can be primary or secondary. Primary dysmenorrhea involves no physical abnormality and usually begins six months to one year after beginning of menstruation. Secondary dysmenorrhea occurs secondary to some causes like endometriosis, uterine fibroids.

Most women experience some pain during their lifetime. Dysmenorrhea is diagnosed if there is severe pain impairing her daily regular activities or pain requiring medications.

Symptoms and signs of dysmenorrhea

  • Dull or throbbing pain in lower abdomen.
  • Pain that radiates to the lower back and thighs.

There are other symptoms in some women pertaining to the same condition.

Causes: Pain during menstruation is caused by prostaglandins, hormone like substances which is involved in pain and inflammation and triggers the uterine muscle contraction leading to pain.

Conditions causing dysmenorrhea

  • Endometriosis.
  • Adenomyosis
  • Pelvic inflammatory disease: Infection of female reproductive organs mainly caused by sexually transmitted disease.
  • Use of intrauterine devices like copper-T.
  • Uterine fibroids and uterine polyps.

Risk factors

  • Age younger than 20.
  • Early onset of puberty (age 11 or younger).
  • Heavy bleeding during periods (Menorrhagia).
  • Depression or anxiety.
  • Attempts to lose weight (in woman aged 14 to 20).
  • Never having delivered a baby.
  • Smoking.


Tests and diagnosis

  • Medical history.
  • Menstrual history.
  • Physical examination.
  • Pelvic examination.
  • Diagnostic tests like: Ultrasound, CT scan, magnetic resonance imaging (MRI). Laparoscopy, hysteroscopy.


Treatment includes treatment of underlying cause example, use of antibiotics to treat infection or surgery to remove fibroids or polyps or to treat endometriosis.

For pain non steroidal anti-inflammatory drugs (NSAID’s) like aspirin, ibuprofen, and naproxen.

For severe pain low dose oral contraceptives are prescribed to prevent ovulation, which may reduce the production of prostaglandins and hence the severity of the cramps.

Lifestyle and home remedies


These are very important part of the treatment. Once the pain begins, soaking in a hot bath or using heating pad on the abdomen are some good ways.

  • Exercise regularly: Exercise results in increase of endorphins, your body’s pain killers.
  • Get adequate rest.

Some women find relief through massage, yoga or meditation or acupuncture therapy.



  • If a diagnosis of secondary dysmenorrhea is missed, the underlying pathology may lead to increased morbidity including sterility.
  • Social isolation and or depression can occur.