Painful Periods (Dysmenorrhea)

It's Not Your Imagination!

Over the years you may have read ... or been told .... that it was "all in your mind" ... that you were exaggerating the actual discomfort ... or that it was simply the price you had to pay for being female. Medical experts, however, have shown that painful menstruation is a physical problem, and that most cases can be successfully treated. 

Symptoms

Dysmenorrhea often includes one or more of such symptoms as mild to severe cramping in the lower abdomen, backache pain and pulling on the inside of the thighs, nausea, vomiting, diarrhea, dizziness, fainting, or headache. If you are like most women who suffer from dysmenorrhea, the symptoms are usually more severe on the first day of flow. They probably decrease as your period continues and in most cases lasts no more than 12-16 hours. However, some women experience discomfort from the beginning to the end of the menstrual flow, which may be for as long as 5-6 days.

A Common Problem 

Dysmenorrhea is the most common cause of lost work and school hours among women in the United States. In fact, 42 million women in the United States suffer from painful menstrual symptoms. Of these, about 3 1/2 million are unable to function for one to two days each month because the condition is so severe.

An Important Cause Has Been Found

In some cases, the cause of dysmenorrhea is an actual disease or some physical abnormality. These conditions may sometimes be difficult to diagnose but they can often be managed with medication and/or surgical intervention. The causes of dysmenorrhea in a normal, healthy woman are not so clear. It has long been believed that heredity, psychological well-being, and environment are important influences. However, the most up-to-date thinking indicates that a group of chemicals in your body called "prostaglandins" may be the most direct influence.

Understanding Your Menstrual Cycle

To have a better understanding of how painful periods occur, it is important to know what happens to your body at the various stages of your menstrual cycle. At the beginning of your period (Day 1 of your cycle), a complex chemical called a hormone travels through your bloodstream and causes one of the thousands of egg cells stored in your ovaries to begin to ripen. As the egg matures, between the fifth and fourteenth day, estrogen levels increase. The estrogen travels through the bloodstream to the uterus, where it causes the lining of the uterus to thicken so that it will be able to nourish a fertilized egg cell.

By about the 14th day after menstruation begins, ovulation takes place. This means that the mature egg cell leaves the ovary and begins its journey through the fallopian tube toward the uterus. Progesterone levels then begin to increase, causing the blood supply to the uterus to increase. If the egg is not fertilized, all this preparation is unnecessary. Thus, the thick, blood-rich lining of the uterus is shed. Along with the unfertilized egg and other cellular matter, it is discharged through the vagina on about the 28th day, and another menstrual cycle begins.

Understanding the Role of Prostaglandins

In addition to the hormones in your body there are the previously mentioned chemicals called prostaglandins. It has been found that prostaglandins are involved in controlling many functions in your body, including intestinal activity; the change in diameter of your blood vessels, and uterine contractions.

Scientists believe that when there is an excess of a certain prostaglandin, uterine contractions are greater, and this causes the severe pain and discomfort of dysmenorrhea. It is also thought that the excess prostaglandin travels through your bloodstream, constricting vessels in various parts of your body and activating your large intestine. Thus, this prostaglandin is responsible for the headaches, dizziness, hot and cold flashes, diarrhea and nausea that can accompany painful periods.

The Problem May Decrease with Age

Dysmenorrhea doesn't usually affect young girls who are just starting their periods, because ovulation does not occur in these early cycles. However, you may have started to experience discomfort within a few months or years after menstruation began. Although physicians do not yet understand why, the condition is most common between the ages of 15 and 25. For many women, the discomfort begins to fade as they reach their late twenties or early thirties.

Fortunately, there are many remedies that may make your periods more comfortable. The application of a hot water bottle or a heating pad to the abdomen during the first few hours of your period may provide some relief. Adequate rest can also be helpful. You should pursue normal activities if possible, including the usual types of physical exercise. 

Medications That Slow Down Prostaglandin Production

Since an excess of prostaglandins in the lining of the uterus seems to be one of the major causes of dysmenorrhea, any medication that reduces the amount of prostaglandins will be helpful in relieving the pain. NSAIDs, such as aspirin, ibuprofen, and naproxen, reduce prostaglandin production slightly, and some women do in fact get relief by taking NSAIDs during their monthly period. Birth control pills have also been shown to help relieve dysmenorrhea. Since they prevent ovulation, they prevent the full development of the lining of the uterus, and thus the amount of prostaglandin present is reduced.