Dysmenorrhoea is the medical term referring to painful periods. When a woman suffers from significantly painful periods from the time of her first period, that is referred to as primary dysmenorrhoea.
What causes dysmenorrhoea?
There main source of pain during periods is contraction of the uterine muscle in response to the release of prostaglandins as the lining of the womb starts to shed. As the contractions increase in strength, they reduce blood supply to the muscle and this lack of oxygen causes the build-up of lactic acid (similar to any other muscle in the body when it is working hard) which causes the pain.
Why is primary dysmenorrhoea more severe in some women, and how common is it?
This is difficult to say as up to 50-90% of women report some significant pain when they start having periods. In up to 17% of cases, it may be severe enough to impact on attendance at school or the ability to work. Severe primary dysmenorrhoea is more common with younger age at onset of menses, family history of primary dysmenorrhoea, prolonged periods, irregular cycles, or heavy periods.
How can primary dysmenorrhoea be managed?
The diagnosis involves the exclusion of potential causes (endometriosis, pelvic inflammatory disease, non-gynaecological causes of pelvic pain) so the first step is to see your family doctor or a gynaecologist for review and appropriate investigation.
Initial management is usually based on relieving the symptoms and this can be done most commonly by on or a combination of the below
- Conservative measures such as heat packs, exercise
- Natural therapies. There is some evidence for the effectiveness of ginger, vitamin E, vitamin B1 and fish oil.
- Dietary changes. There is some evidence that a low fat vegetarian diet or an increased dairy intake may be of benefit.
- Physiotherapy to assist with managing pelvic floor spasm that may occur in response to pelvic pain, setting up a pain cycle that can be difficult to break
- Prescribed medication which may be used alone or in some combination
- non-hormonal (non-steroidal anti-inflammatories, anti fibrinolytics)
- Hormonal (combined oral contraceptive, progestin only preparations (oral, implantable, injectable or intrauterine device)
In the case of persistent primary dysmenorrhoea that is not responding to conservative or medical therapy, consideration of conditions such as endometriosis may lead to the decision to perform diagnostic keyhole surgery to assess and treat conditions such as endometriosis.
Can primary dysmenorrhoea be prevented?
Unfortunately there is no evidence of effective preventative measures, but the treatment measures outlined above have good efficacy in most cases. Symptoms also tend to lessen over time as a woman’s cycles become more regular.