What Causes Painful Menstruation?
Menstruation occurs when the uterus sheds its lining once a month. The lining passes through a small opening in the cervix and out through the vaginal canal.
Some pain, cramping, and discomfort during menstrual periods is normal. Excessive pain that causes you to miss work or school is not.
Painful menstruation is also called dysmenorrhea. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs in women who experience pain before and during menstruation. Women who have had normal periods that become painful later in life may have secondary dysmenorrhea. A condition affecting the uterus or other pelvic organs, such as endometriosis or uterine fibroids, can cause this.
What are the causes?
There may not be an identifiable cause of your painful menstrual periods. Some women are at a higher risk for having painful menstrual periods. These risks include:
- being under age 20
- having a family history of painful periods
- smoking
- having heavy bleeding with periods
- having irregular periods
- never having had a baby
- reaching puberty before age 11
A hormone called prostaglandin triggers muscle contractions in your uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.
Painful menstrual periods can also be the result of an underlying medical condition, such as:
- premenstrual syndrome (PMS): a group of symptoms caused by hormonal changes in the body that occur 1 to 2 weeks before menstruation begins and go away after a woman begins to bleed
- endometriosis: a painful medical condition in which cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis
- fibroids in the uterus: noncancerous tumors that can put pressure on the uterus or cause abnormal menstruation and pain
- pelvic inflammatory disease (PID): an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that causes inflammation of the reproductive organs and pain
- adenomyosis: a rare condition in which the uterine lining grows into the muscular wall of the uterus and can be painful because it causes inflammation and pressure
- cervical stenosis: a rare condition in which the cervix is so small it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain
Home treatment
Home care treatments may be successful in relieving painful menstrual periods and can include:
- using a heating pad on your pelvic area or back
- massaging your abdomen
- taking a warm bath
- regular physical exercise
- eating light, nutritious meals
- practicing relaxation techniques or yoga
- taking an anti-inflammatory medication such as ibuprofen several days before your expected period
- taking vitamin B-6, vitamin B-1, vitamin E, omega-3 fatty acids, calcium, and magnesium supplements, and reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating
- raising your legs or lying with your knees bent
When to call a doctor
If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to your gynecologist. Talk to your doctor about your symptoms and if you experience any of the following:
- continuing pain after IUD placement
- at least three painful menstrual periods
- passing blood clots
- cramping accompanied by diarrhea and nausea
- pelvic pain when not menstruating
Sudden cramping or pelvic pain could be signs of infection. An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility. If you have symptoms of an infection, seek prompt medical attention. Symptoms include:
- fever
- severe pelvic pain
- sudden pain, especially if you may be pregnant
- foul-smelling vaginal discharge
Diagnosis
Your doctor will first take your medical history to check for the underlying causes of your painful menstrual periods. They will also perform a physical examination. This will include a pelvic exam to check for any abnormalities in your reproductive system and to look for signs of infection.
If your doctor thinks an underlying disorder is causing your symptoms they may perform imaging tests. These may include:
- ultrasound: a handheld device that sends out sound waves is moved over the skin to see inside your body
- CT scan: a noninvasive detailed imaging test that uses X-rays to see inside your body
- MRI: a noninvasive detailed imaging test that uses magnetic fields and radio waves to see inside your body
Depending on the results of your imaging tests, your doctor may order a laparoscopy. This is a test in which a doctor makes small incisions in the abdomen into which they insert a fiber-optic tube with a camera at the end to see inside your abdominal cavity.
Medical treatment
If home treatment does not relieve your menstrual pain, there are some medical treatment options. Treatment will depend on the severity and underlying cause of your pain. If PID or sexually transmitted infections (STIs) are causing your pain, your doctor will prescribe antibiotics to clear the infections.
Your doctor may also prescribe medications that include:
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Heavy, Prolonged, or Irregular Menstrual Periods
The duration and severity of menstrual bleeding varies from woman to woman. It’s known as menorrhagia if a woman’s menstrual period is excessively heavy, prolonged, or irregular.
Symptoms of menorrhagia include a menstrual period that lasts longer than seven days, and bleeding is so heavy that you must change your tampon or pad more than once per hour. You should see your doctor if you have excessively heavy or prolonged menstrual periods that interfere with your daily life.
Excessive bleeding can cause anemia, or iron deficiency, and may signal an underlying medical condition. In most cases, a doctor can successfully treat abnormal periods.
What Causes Heavy or Irregular Menstrual Periods?
Heavy or irregular periods can be due to a variety of factors, including:
Medications
Some anti-inflammatory drugs, anticoagulants, or hormone medications can affect menstrual bleeding.
Heavy bleeding can be a side effect of intrauterine devices used for birth control.
Hormone Imbalances
The hormones estrogen and progesterone regulate the buildup of the lining of the uterus. An excess of these hormones can cause heavy bleeding. Hormone imbalances are most common among girls who began menstruating in the past year and a half. They’re also common in women who are getting close to menopause.
Medical Conditions
PID
Pelvic inflammatory disease (PID) and other infections can cause irregular periods, as can endometriosis. This is a condition in which tissue that lines the inside of the uterus begins to grow elsewhere inside the body. This can cause heavy bleeding, as well as pain.
Inherited Blood Disorder
Heavy menstrual bleeding can also be due to some inherited blood disorders that affect clotting.
Benign Growths or Cancers
Cervical, ovarian, or uterine cancer can all cause heavy bleeding, but these conditions are not common. Benign, or noncancerous, tumors in the uterus can cause heavy bleeding or long periods. Benign growths in the uterine lining (endometrium) can cause a heavy or prolonged period. These growths are known as polyps, when the growth is made up of endometrial tissue, or fibroids, when the growth is made up of muscle tissue.
Other Possible Causes
Annovulation
Lack of ovulation, or anovulation, results in a lack of the hormone progesterone, causing heavy periods.
Adenomyosis
When glands from the uterine lining embed in uterine muscle, heavy bleeding can occur. This is known as adenomyosis.
Ectopic Pregnancy
You should contact your doctor if you bleed during pregnancy. Normal pregnancy interrupts menstruation. Some spotting during pregnancy, especially during the first trimester, is often nothing to worry about. Seek immediate medical attention if you bleed heavily during pregnancy. It can be a sign that the fertilized egg implanted in the fallopian tube rather than the uterus, which is called an ectopic pregnancy. It can also indicate a miscarriage. Your doctor will be able to help you figure out what’s causing any bleeding during pregnancy.
What Are the Symptoms of Heavy or Irregular Periods?
The length of the menstrual cycle and amount of blood flow is unique to each woman. However, most women have a cycle that ranges from 24 to 34 days. Blood flow averages about four or five days, with a blood loss of about 40 cc (3 tablespoons). It’s important to remember that these are just averages, and that your “normal” may fall outside of these ranges.
A blood loss of 80 cc (5 tablespoons) or more is an abnormally heavy flow. Signs that your flow may be abnormally heavy include soaking through more than one tampon or sanitary pad in an hour, for several hours at a time. You may need to double up on sanitary pads, or use both a tampon and a pad. An abnormally heavy flow may cause you to wake up during the night because you need to change protection. You may not be able or willing to participate in your normal activities because your flow is too heavy. Sometimes, an abnormally heavy flow will contain large blood clots, or last more than a week. Also, an abnormally heavy flow can cause you to experience the following symptoms, which may be an indication of anemia:
- fatigue
- pale skin
- shortness of breath
- dizziness
While every woman’s cycle is different, irregularities such as bleeding mid-cycle or bleeding after intercourse are abnormal symptoms.
When Should I Seek Medical Care?
You should see your gynecologist once a year for a checkup. However, you should make an appointment right away if you have bleeding or spotting in the following circumstances:
- between periods
- after sex
- while pregnant
- after menopause
Other indicators that you should consult your doctor include the following:
- if your periods consistently last for more than a week
- if you require more than one tampon or sanitary pad in an hour, for several hours in a row
- severe pain
- fever
- abnormal discharge or odor
- unexplained weight gain or loss
- unusual hair growth
- new acne
- nipple discharge
Keep track of your menstrual cycles, including how long your blood flow lasts, and how many tampons or sanitary pads you use during each cycle. This information will be helpful at your gynecological appointment.
Avoid products that contain aspirin because they may increase bleeding.
How Are Heavy or Irregular Menstrual Periods Diagnosed?
If you have abnormal menstrual periods, your doctor will probably begin with a pelvic examination. They will take your medical history, and you should list all the medications and supplements you’re taking.
Depending on your specific symptoms, diagnostic testing may include:
Pap Smear
This test is to check for various infections or cancerous cells
Blood Tests
Blood tests will be used to check for anemia, blood-clotting problems, and thyroid function.
Pelvic Ultrasound
A pelvic ultrasound will produce images of your uterus, ovaries, and pelvis.
Endometrial Biopsy
If your doctor wants to evaluate possible issues with your uterus, they may order an endometrial biopsy, in which a sample of your uterine tissue is taken so it can be analyzed. They may also use a diagnostic hysteroscopy to view the inside of your uterus. For a hysteroscopy, your doctor will use a lighted tube to view the uterus and remove the polyp.
Sonohysterogram
They may also use a sonohysterogram, an ultrasound that involves the injection of fluid into your uterus to help make an image of your uterine cavity. Your doctor will then be able to look for polyps or fibroids.
Pregnancy Test
Your doctor may request a pregnancy test.
What Are the Treatment Options for Heavy or Irregular Menstrual Periods?
Treatment will depend on your overall health, the reason for your menstrual abnormalities, and your reproductive history and future plans. Your doctor will also need to address any underlying medical conditions, such as thyroid dysfunction. Treatments may include the following.
Medication
Possible medication treatments your doctor may suggest include:
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