A guide to Understanding and Managing Period Pain

Introduction

Period pain, also known as dysmenorrhea, is one of the most common gynaecological symptoms experienced by menstruating women¹. It occurs during menstruation and is characterized by cramping and discomfort in the lower abdomen and may radiate through to the back and inner thigh. Period pains can typically last from 8 to 72 hours. While it is a natural part of the menstrual cycle, period pain can vary in intensity and may disrupt daily activities for some. This article aims to provide a comprehensive understanding of period pain, its causes, and effective management strategies.

Types of Period Pain

1. Primary Dysmenorrhea

Primary dysmenorrhea refers to menstrual pain that occurs without any underlying medical condition. It typically starts during adolescence, a few years after menstruation begins. The pain is caused by the release of prostaglandins, hormone-like substances that cause the uterus to contract and shed its lining. Primary dysmenorrhoea is a common reason for work absenteeism with up to 50% of women reporting at least one absence and 5-14% reporting frequent absences². Smoking, early age at onset of periods, having periods that last a long time, and having no children are risk factors for developing period pains.

2. Secondary Dysmenorrhea

Secondary dysmenorrhea is menstrual pain that arises from an underlying medical condition. It usually occurs one to two decades after the onset of periods. Conditions such as endometriosis (most commonly), uterine fibroids, intrauterine polyps, chronic pelvic inflammatory disease (PID), and adenomyosis can cause more severe and prolonged pain during menstruation. Accompanying symptoms such as irregular and heavy bleeding, discharge, and painful intercourse may point to an underlying medical problem³.

Prevalence

The underlying prevalence of period pain is difficult to determine as it’s often underestimated and underreported⁴. It is more commonly observed in younger than older women affecting 67-90% of women aged 17 to 24 years⁵.

Causes and Triggers

1. Prostaglandins

As mentioned earlier, prostaglandins play a significant role in primary dysmenorrhea⁶. These hormones are responsible for uterine contractions, which can lead to cramping and pain.

2. Hormonal Imbalance

Fluctuations in hormone levels, particularly oestrogen and progesterone, can influence the severity of period pain.

3. Underlying Medical Issues

Conditions like endometriosis, uterine polyps and uterine fibroids can lead to abnormal tissue growth, resulting in more intense menstrual pain.

4. Lifestyle Factors

Stress, lack of exercise, and poor dietary habits can exacerbate period pain.

Managing Period Pain

1. Pain Medication

Over-the-counter pain relievers, such as paracetamol (adult: 1,000mg orally four times daily) and ibuprofen (adult: 200-400mg orally three times daily), can help alleviate cramps and reduce inflammation during menstruation. Always follow the recommended dosage and consult a healthcare professional if you have any concerns. Mefenamic Acid (Brand names: Femin / Ponstan) is an effective prescription medicine indicated for dysmenorrhea and menorrhagia (adult: 500mg orally three times daily)⁷.

2. Heat Therapy

Applying a heating pad or taking a warm bath can relax the pelvic muscles and provide relief from menstrual cramps and may be at-least as effective as anti-inflammatory medication^8,9.

3. Exercise

Regular physical activity, especially aerobic exercises like walking, swimming, or cycling, can help reduce period pain by increasing blood flow and releasing endorphins, the body's natural painkillers¹⁰.

4. Relaxation Techniques

Practicing relaxation techniques like deep breathing, meditation, and yoga can alleviate stress, which, in turn, may help reduce the severity of period pain.

5. Lifestyle and Dietary Changes

Quitting smoking, reducing stress and consuming a balanced diet with plenty of fruits, vegetables, and whole grains can promote overall health and may positively impact period pain. Additionally, reducing caffeine and salt intake can help reduce bloating and discomfort¹¹.

6. Herbal Remedies

Some people find relief from period pain by using certain herbal remedies, such as ginger, cinnamon, and chamomile tea. However, it's essential to consult a healthcare professional before using any herbal supplements¹².

7. Hormonal Contraception

Certain hormonal contraceptives, such as oral contraceptive pills or hormonal IUDs, can help manage period pain by regulating hormone levels and reducing menstrual flow¹³.

When to Seek Medical Advice

While period pain is common, severe or debilitating pain should not be ignored. If you experience any of the following symptoms, it is essential to consult a healthcare professional:

- Severe and persistent pain that interferes with daily activities.

- Irregular or heavy menstrual bleeding.

- Pain during or after sexual intercourse.

- Menstrual pain that begins later in life (after 25 years) and is not typical for you.

Conclusion

Period pain is a natural part of the menstrual cycle, but it can vary widely in intensity and impact daily life for some individuals. Understanding the types, causes, and triggers of period pain is crucial in managing it effectively. By adopting healthy lifestyle habits, using pain relief measures, and seeking medical advice when necessary, individuals can find relief and maintain their overall well-being during menstruation. Remember, each person's experience with period pain is unique, and it's essential to find what works best for you through trial and error while always prioritising your health and comfort.

References

1. Fernández-Martínez E, Onieva-Zafra MD, Parra-Fernández ML. The impact of dysmenorrhea on quality of life among Spanish female university students. Int J Environ Res Public Health. 2019 Feb 27;16(5):713.

2. Burnett MA, Antao V, Black A, et al. Prevalence of primary dysmenorrhea in Canada. J Obstet Gynaecol Can. 2005;27:765-770.

3. Dawood MY. Dysmenorrhea. Clin Obstet Gynecol. 1990;33:168-178.

4. Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ. 2006;332:1134-1138.

5. Kennedy S. Primary dysmenorrhoea. Lancet. 1997 Apr 19;349(9059):1116.

6. Lumsden MA, Kelly RW, Baird DT. Primary dysmenorrhoea: the importance of both prostaglandin E2 and F2 alpha. Br J Obstet Gynaecol. 1983;90:1135-1140.

7. Therapeutic Guidelines Ltd. Introduction to primary dysmenorrhoea. Therapeutic guidelines (Dec 2020). Url: https://tgldcdp.tg.org.au [accessed 24/07/2023].

8. Lee et al. A multicenter, randomized, double-blind, placebo-controlled, trial evaluating the efficacy and safety of a far infrared-emitting sericite belt in patients with primary dysmenorrhoea. Complement Ther Med. 2011 Aug;19(4)187-93. doi: 10.1016/j.ctim.2011.06.004.

9. Kannan P, Claydon LS. Some physiotherapy treatments may relieve menstrual pain in women with primary dysmenorrhoea: a systematic review. 2014 Mar;60(1):13-21. doi: 10.1016/j.jphys.2013.12.003.

10. Armour et al. Exercise for dysmenorrhoea. Cochrane Database Syst Rev. 2019 Sep 20;9(9):CD004142. doi: 10.1002/14651858.CD004142.pub4.

11. Barnard et al. Diet and sex-hormone binding globulin, dysmenorrhoea, and premenstrual symptoms. Obstet Gynecol 2000 Feb;95(20)245-50. doi: 10.1016/s0029-7844(99)00525-6.

12. Zhang et al. Association of tea drinking and dysmenorrhoea among reproductive-age women in Shanghai, China (2013-2015): a cross sectional study. BMJ Open. 2019 Apr 8;9(4):e026643. Doi: 10.1136/bmjopen-2018-026643.

13. Wong et al. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev 2009 Oct 7;2009(4):CD002120. doi: 10.1002/14651858.CD002120.pub3.