Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes

Menstruation occurs when the uterus sheds its lining once a month. Some pain, cramping, and discomfort during menstrual periods are normal; excessive pain that causes a person 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 people who experience pain before and during menstruation. Having a normal period that becomes painful later in life may be secondary dysmenorrhea. A condition affecting the uterus or other pelvic organs, such as endometriosis or uterine fibroids, can cause this.

It’s not always possible to identify the cause of painful menstrual periods. Some people are just at a higher risk of having painful periods. These risks include:
* Age below 20
* Family history of painful periods
* Smoking
* Heavy bleeding with periods
* Irregular periods
* Never having had a baby
* Puberty before age 11

A hormone called prostaglandin triggers muscle contractions in the uterus, and those contractions expel the lining. Those 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). PMS is a common condition that’s caused by hormonal changes in the body, occurring 1 to 2 weeks before menstruation begins. Symptoms typically go away after bleeding begins.

* Endometriosis. This is 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. Fibroids are noncancerous tumours that can put pressure on the uterus, or cause abnormal menstruation and pain; though they often don’t cause symptoms.

* Pelvic inflammatory disease (PID). PID is an infection of the uterus, fallopian tubes, or ovaries. It is often caused by sexually transmitted bacteria that cause inflammation of the reproductive organs and pain.

* Adenomyosis. This is a rare condition in which the uterine lining grows into the muscular wall of the uterus, causing inflammation, pressure, and pain. It can also cause longer or heavier periods.

* Cervical stenosis. Cervical stenosis is a rare condition, in which the cervix is so small or narrow that it slows menstrual flow, causing an increase of pressure inside the uterus, which causes pain.

When trying to find out what is the underlying cause of painful menstruation, doctors would likely take a medical history and perform a physical exam. This would include a pelvic examination to check for any abnormalities in the reproductive system and to look for signs of infection. If a doctor thinks an underlying disorder is causing the symptoms, imaging tests may be performed. These can include:
* an ultrasound
* a CT scans
* an MRI

Depending on the results of the imaging tests, a 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.

At-home treatments can be helpful in relieving painful menstrual periods. Types of things to try at home include:
* Heating pad on the pelvic area or back
* Massaging the abdomen
* Taking a warm bath
* Regular physical exercise
* Eating light, nutritious meals
* Practising relaxation techniques or yoga
* Taking anti-inflammatory medications such as ibuprofen several days before you expect your period
* Raising the legs, or lying with the knees bent
* Reducing the intake of salt, alcohol, caffeine, and sugar to prevent bloating
* Vitamins and supplements such as:
o vitamin B-6
o vitamin B-1
o vitamin E
o omega-3 fatty acids
o calcium
o magnesium

If at-home treatment doesn’t relieve menstrual pain, medical treatment options exist.
Treatment will depend on the severity and underlying cause of your pain. If PID or sexually transmitted infections (STIs) are causing the pain, a doctor would prescribe antibiotics to clear the infection. Prescribed medications may also include:

* Nonsteroidal anti-inflammatory drugs (NSAIDs). Other pain relievers. This includes over-the-counter options like acetaminophen (Tylenol) or stronger prescription pain medications.

* Antidepressants. Antidepressants are sometimes prescribed to help lessen some of the mood swings associated with PMS.

* Doctors may also suggest trying hormonal birth control. Hormonal birth control is available as a pill, patch, vaginal ring, injection, implant, or IUD. Hormones prevent ovulation, which can control your menstrual cramps.

* Surgery can treat endometriosis or uterine fibroids. This is an option if other treatments haven’t been successful. The surgery removes any endometriosis implants, uterine fibroids, or cysts.

In rare cases, a hysterectomy (the surgical removal of the uterus) is an option if other treatments haven’t worked and the pain is severe. Having a hysterectomy would result in women no longer being able to have children. This option is usually only used if someone isn’t planning on having children, or is at the end of their childbearing years.
If menstrual pain is interfering with one’s ability to perform basic tasks each month, it may be time to talk to a gynaecologist. Talk to a doctor about any symptoms if you are experiencing any of the following:
* Continuing pain after IUD placement
* At least three painful menstrual periods
* Passing blood clots
* Cramping, accompanied by diarrhoea and nausea
* Pelvic pain when not menstruating
* Sudden cramping or pelvic pain could be a sign of infection. An untreated infection can cause scar tissue, which damages the pelvic organs and may lead to infertility.
If having symptoms of an infection, seek prompt medical attention:
* Fever
* Severe pelvic pain
* Sudden pain, especially if pregnant
* Foul-smelling vaginal discharge.