Painful menstrual periods, also called dysmenorrhea, may include pain in the pelvis, abdomen, back, or legs, abdominal cramps, headache, and fatigue. Most women have painful periods at some time in their lives. In some women, the pain is severe enough to interfere with normal activities.
There are 2 types of dysmenorrhea:
- Primary—painful regular menstrual cycles caused by uterine muscle contractions
- Secondary—painful periods due to an underlying condition, such as endometriosis
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Primary dysmenorrhea is caused by high levels of prostaglandins in the uterus. Prostaglandins are hormone-like substances normally found throughout the body.
Secondary dysmenorrhea can be caused by:
- Ovarian cysts
- Infection of the female reproductive organs—pelvic inflammatory disease
- Noncancerous growths in the uterus—uterine fibroids
- Intrauterine device (IUDs)
- Scars inside the abdomen from previous surgery
- Inflammatory bowel disease
Painful menstrual periods are more common in women under age 30 years. Other factors that may increase your risk of having painful menstrual periods include:
- Low body weight, especially during adolescence
- Early onset of menstruation—younger than 12 years old
- Longer menstrual cycles
- Heavy bleeding during periods
- Never having delivered a baby
- Psychological disorders, such as depression or anxiety
You are also at risk if you have a related condition, such as endometriosis or ovarian cysts.
The pain associated with either primary or secondary dysmenorrhea may be sharp and throbbing, or dull and aching. It is most typically located in the lower abdomen and may spread to the low back or thighs. Other symptoms may include:
You will be asked about your symptoms and medical history. A pelvic exam will be done.
Specific tests can evaluate your pelvic organs and surrounding structures. Tests may include:
- Pelvic ultrasound
- Pelvic laparoscopy
Primary dysmenorrhea is usually treated with medications and lifestyle changes.
The treatment of secondary dysmenorrhea varies depending on the underlying condition.
To help reduce your chance of painful menstrual periods:
- Exercise regularly
- If you smoke, talk to your doctor about how you can quit
- Drink only moderate amounts of caffeine and alcohol