Having your periods can be one of the most physically and emotionally exhausting times of the month if it is associated with pain, discomfort, and cramping. Periods pain is usually felt in your lower abdomen, lower back and sometimes, in the lower limbs. It is normal for 50 – 55% of women to have mild abdominal cramps on the first day or two of their period and about 10% of women experience severe pain.

Menstrual pain or cramps (dysmenorrhoea) are throbbing pains in your lower abdomen that you experience, either before or during your periods/menstruation. 

Menstruation is the normal vaginal bleeding that occurs as a part of a woman's monthly cycle. The average menstrual cycle is 28 days, but this can vary in some women due to various diseases/factors.

Dysmenorrhoea is generally accompanied with nausea, vomiting, and headaches which can result in extreme fatigue, weakness, and irritability. 

Before we dive into the types, causes, symptoms, and treatment of dysmenorrhoea, let’s quickly know the various parts of your reproductive system to understand the concept of dysmenorrhoea better. 

Your internal reproductive system consists of the vagina, uterus, fallopian tubes, and ovaries. 

  • The vagina is an elastic, muscular canal with a soft, flexible lining that connects your uterus (an inverted pear-shaped muscular organ) to the outside world. 

  • The fallopian tubes, also known as uterine tubes, are tubes that stretch from your uterus to the ovaries.

  • Ovaries are the primary female reproductive organs that secrete hormones and release eggs for fertilization.

Types of Dysmenorrhea

There are two types of dysmenorrhea. 

Primary dysmenorrhea is menstrual pain that is not a symptom of an underlying gynaecologic disorder but is related to the normal process of menstruation. 

  • Thi is seen mostly in adolescent girls. Adolescence is a transitional stage from childhood to adulthood that occurs between 13 and 19 years.

  • Fortunately for many women, the problem eases as they mature, particularly after a pregnancy. Although it may be painful and sometimes debilitating for brief periods of time, it is not harmful.

Secondary dysmenorrhea is menstrual pain that is generally related to some kind of gynaecologic disease/disorder. 

  • Most of these diseases/disorders can be easily treated with medications or surgery. 

  • Secondary dysmenorrhea is more likely to affect women during adulthood.

Causes of Primary and Secondary Dysmenorrhea

Primary dysmenorrhea is caused by excessive levels of prostaglandins that make your uterus (a hollow muscular organ located between your bladder and rectum) contract during menstruation. Prostaglandins are active lipid compounds that cause pain and inflammation. Increased levels of prostaglandins are associated with increased menstrual cramps. 

Lack of exercise, psychological or social stress, smoking, drinking alcohol, being overweight, etc. increases the levels of prostaglandins.

Secondary dysmenorrhea may be caused by a number of conditions such as:

  • Fibroids. These are benign tumours that develop within the wall of the uterus or are attached to it.

  • Adenomyosis. This is a condition in which the tissue that lines the uterus (called the endometrium) begins to grow within its muscular walls.

  • Sexually transmitted diseases (STDs). A sexually transmitted disease like chlamydia or gonorrhea can cause pelvic inflammatory disease (PID), which in turn can be a cause for secondary dysmenorrhea. 

  • Endometriosis. This is a painful disorder in which the tissues that line the inner walls of your uterus (endometrium) start to grow outside the uterus.

  • Pelvic inflammatory disease (PID). This is primarily an infection of the fallopian tubes but can also affect the ovaries, uterus, and cervix.

  • IUDs. The use of an intrauterine device (IUD), a birth control method.

Symptoms of Primary and Secondary Dysmenorrhea

Primary Dysmenorrhea

  • Sharp, intermittent episodes of pain radiating to the lower back, calf muscles, or legs

  • Nausea and vomiting

  • Diarrhea

  • Fatigue

  • Fever

  • Headache or lightheadedness

Secondary Dysmenorrhea

Symptoms usually result from specific pelvic diseases. The symptoms of secondary dysmenorrhea (pain starting before the onset of bleeding and continuing throughout) often start sooner in the menstrual cycle than those of primary dysmenorrhea, and usually last longer. 

Common symptoms include:

  • Irregular periods

  • Bleeding between periods

  • Pain between periods 

  • Heavy menstrual bleeding (more than in the previous cycle) 

  • Vaginal discharge

  • Pain during sex

  • Pain in your rectum 

  • Inability to conceive even after unprotected sexual intercourse

Dysmenorrhea pain may be spasmodic (sharp pelvic cramps at the start of menstrual flow) or congestive (deep, dull ache). For most women, the pain usually starts before or during their menstrual period, peaks within 24 hours, and subsides after 2 to 3 days. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain.


Primary Dysmenorrhea

1. Apply heat to your abdomen and lower back. This may relieve pain. Heat therapy works by relaxing the muscles of the uterus, increasing blood flow, and easing pain. 

2. Take a warm bath. This can ease menstrual cramps. It works similarly to heat therapy. 

3. Avoid strenuous physical activity. Doing mild exercises like stretching, walking, or biking is recommended. Light exercises may improve blood flow and reduce pelvic pain.

4. Gently massage your abdomen with essential oils. Massages may reduce contractions by relaxing the uterus and reducing pain. Use lavender oil, rose oil, peppermint oil, and clove oil for your massage.

5. Stay hydrated, get plenty of rest and avoid stressful situations/triggers as your period approaches. 

  • Drinking hot water can increase blood flow throughout your body and relax your muscles. 
  • Staying stress-free will control the release of prostaglandins and reduce menstrual cramps or pain.

6. Practice yoga, acupressure and acupuncture to reduce overall stress and to keep painful cramps at bay. 

  • Yoga, a mind and body practice, is a combination of different physical postures, breathing, and relaxation techniques along with a feeling of spirituality. 
  • Acupressure is an age-old Chinese medicine technique that involves putting pressure on certain soft points on your body to relieve pain. 
  • Acupuncture is another healing practice of traditional Chinese medicine in which thin needles are placed at specific points of the body, to reduce pain. 

7. Painkillers for mild pain due to dysmenorrhoea. Painkillers can be taken on the advice of your physician. It is recommended that one should use hot fomentation (or heat therapy) also along with a painkiller if the pain is severe. Pain medications should always be taken on a full stomach. If taken empty stomach they can have side effects of nausea, dyspepsia (indigestion or bloating), peptic ulcers, etc. 

8. Hormonal pills can improve or relieve symptoms of primary dysmenorrhea, if given for a few cycles. Your doctor can prescribe low doses of oral pills after a thorough investigation. 

Usually, no investigations are recommended for dysmenorrhoea of adolescents.

Management of secondary dysmenorrhoea depends upon the underlying cause and your doctor will guide you accordingly.

Dysmenorrhea is common and primary causes of pain can be managed at home. Talk to your gynaecologist to understand more about painful period cramps and follow their advice accordingly.

Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.