Dysmenorrhoea is the medical name given to severe, frequent menstrual cramps. Painful periods are common during the late teens and early 20s. The problem gets better after age 25 and after childbirth. Even though period cramps are painful, they are not harmful and will not affect your fertility.

It is estimated that 10 to 15 percent of women with menstrual cramps have symptoms severe enough to interfere with their normal daily activities. Dysmenorrhoea is the main cause of short-term absences in school age girls. In adult women untreated dysmenorrhoea is an important cause of reduced work productivity.

Cramping pain or discomfort in the lower abdomen is the commonest symptom of dysmenorrhoea but the following symptoms can also occur:

• lower back pain;
• dizziness/feeling faint;
• nausea /vomiting;
• loose bowel movements;
• discomfort in the front of the thighs or inner thighs.

What causes painful periods?

Dysmenorrhoea is divided into two types depending on the cause of the pain: primary dysmenorrhoea (the commonest type) and secondary dysmenorrhoea.

In primary dysmenorrhoea there is no underlying medical cause. During a period, chemicals called prostaglandins cause the uterus to contract. Women who have painful periods have larger amounts of prostaglandins causing painful contractions. Pain begins shortly before or at the beginning of a period and can last from a few hours to a few days.

Primary dysmenorrhoea is commonest in young women and starts a few years after the first period.

Secondary dysmenorrhea is usually secondary to, or results from, a specific disease or disorder. These disorders include:

Endometriosis.

This occurs when the endometrial (lining of the womb) tissue becomes implanted outside the uterine cavity, usually in other areas of the pelvis. In one study of adolescents, endometriosis was the most common cause of menstrual pain that did not respond to over-the-counter painkillers.

Endometriosis should be highly suspected in women with severe menstrual cramps who also have infertility. Laparoscopy, an invasive diagnostic procedure, is the only definitive method for diagnosing endometriosis.

Pelvic inflammatory disease.

This is caused by a uterine infection that can spread to the fallopian tubes, ovaries, and other tissues in the pelvis. It may be sexually transmitted.

• Cervical stenosis (narrowing of the opening to the uterus).
• Uterine fibroids.
• Uterine polyps.
• Intrauterine devices (IUDs) can also cause menstrual cramping.

In secondary dysmenorrhoea the pain may begin several days before the period and can last throughout the period.

Are some women more likely to get period pain?

Certain women are more likely to suffer from menstrual cramps.

• Early puberty. Girls who start menstruating at age 11 or younger are at higher risk for severe pain, longer periods, and longer menstrual cycles.  
• Studies suggest that being either overweight or underweight increases the risk for dysmenorrhoea.
• Smokers are twice as likely as non-smokers to suffer from menstrual pain.
• Genetic factors may play a role in over half of primary dysmenorrhoea cases.

Should I see my doctor?

If painful periods are interfering with your daily activities, you should visit your doctor. Effective treatment is available to relieve your symptoms. It may be helpful to keep a menstrual diary so that you can track when your periods occur, how long they last, how heavy they are, and when you get menstrual cramps.

Some questions your doctor may ask include:

• When does the pain occur?  
• Do any non-prescription pain medicines relieve the pain?
• Do you have any other symptoms?  
• If you are taking birth control pills, do they relieve or the pain or make it worse?  
• Is the pain getting worse over time?
• Do you miss school or work because of cramps?  
• Any family history of menstrual problems?
• Do you have a history of any medical conditions that might be causing pelvic pain?

In addition, you may also be asked about your diet (including caffeine intake) and your sexual history.

Your doctor will do a physical examination and pelvic examination and a blood sample may be taken. You may need an ultrasound scan of your pelvis to check your uterus and ovaries. If endometriosis or pelvic inflammatory disease is suspected, you may be referred to a specialist for investigation.

What treatment is available?

Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen are very effective for menstrual cramps and many are available without prescription. Besides being effective pain-killers, they block prostaglandins (the substances that increase uterine contractions). Certain NSAIDs are available on prescription only.

COX-2 (cyclooxygenase-2) inhibitor NSAIDs are less harmful to the gastrointestinal tract than standard NSAIDs.

NSAIDs need to be taken at the first sign of bleeding or cramping. If your periods are regular and you can predict when your period will start, take the anti-inflammatory one day before you expect your period to help prevent cramping.

These medications should be taken with food or milk to reduce possible side effects such as nausea and heartburn.

Hormonal treatment
The oral contraceptive pill decreases cramping by decreasing prostaglandin production.
Intrauterine devices (IUDs) that release progestin (e.g.Mirena coil) and slow release depot progesterone injections (Depo-provera) also help dysmenorrhoea.

Causes of secondary dysmenorrhoea such as endometriosis or pelvic inflammatory disease may need specific treatment.

Besides medication and hormone treatment, there are a few steps you can take in your day-to-day life to lessen menstrual cramping:

• Get plenty of rest. You are more likely to have menstrual pain if you are over-tired.

• Get plenty of exercise. Exercise such as walking, swimming, or cycling can improve blood flow and ease menstrual pain.

• Eat a healthy diet rich in whole grains, fresh fruit, and green leafy vegetables.

• Avoid foods and beverages that contain caffeine, (coffee, tea, colas, and chocolate), saturated fats and commercial junk foods just before and during your period.  

• Drink plenty of fluids.

• Use a heating pad or hot water bottle on your lower back or tummy.

• Soak in a warm (not hot) bath.

• Gently massage your lower abdomen or lower back.

Do pelvic tilt exercises to help menstrual pain: Stand with your feet about a foot apart and your knees bent. Place your hands on your hips near the hip bone. Rock your pelvis forward and back 10 to 15 times.

This can also be done while lying on your back with your knees bent. Tilt the abdomen upward keeping your bottom on the floor and then press the small of your back into the floor.

• Avoid prolonged standing.  
• Have regular yearly checkups, including a Pap test.  
• Yoga and other relaxation techniques may also be helpful.

When should I call my doctor?

Contact your doctor if;

• The pain does not happen at the usual time or does not seem like normal menstrual cramps.
• The pain is very severe.
• The pain lasts longer than 2 or 3 days.