Although many women experience mild or moderate pain during menstrual periods, in approximately 1 out of every 10 women, menstrual pain can reach a level that severely affects quality of life, significantly impairing work capacity and psychological well-being. We will try to address this important issue in a woman’s life through a question-and-answer format.

What is painful menstruation?

It is a cramp-like or aching pain that usually begins 1-2 days before menstrual bleeding and continues for 1-2 days after the onset of bleeding, often felt in the groin and sometimes radiating to the inner thighs. An important characteristic is that this pain is severe enough to interfere with daily activities and work.

How common is painful menstruation?

Menstrual pain is present in approximately 1 out of every 2 women, while severe painful menstruation (dysmenorrhea) is observed in about 1 out of every 10 women.

What types of painful menstruation are there?

Based on their causes, painful menstruation is classified as primary (without an underlying cause) and secondary (due to an underlying cause).

What is Primary Painful Menstruation (primary dysmenorrhea)?

These are painful menstrual periods that typically begin 1-2 years after the first menstruation and cannot be attributed to any underlying cause. The cause is substances called prostaglandins released from the inner lining of the uterus. These substances are secreted under the influence of progesterone hormone released after ovulation. Prostaglandins cause uterine contractions and consequently pain. Therefore, painful menstruation is seen during ovulatory cycles. The severity of primary dysmenorrhea decreases with increasing age or after childbirth.

What is Secondary Painful Menstruation (secondary dysmenorrhea)?

These are painful periods that occur in the later years of the reproductive period and generally become more pronounced and severe over time. Secondary dysmenorrhea occurs due to an underlying cause and usually lasts longer than primary dysmenorrhea.

What are the causes of secondary painful menstruation?

The most important underlying causes of secondary dysmenorrhea can be listed as follows:

  • Endometriosis: Endometriosis, a condition in which the uterine lining (endometrium) is located outside the uterus, is one of the most important causes of secondary dysmenorrhea. These ectopic tissues can be found in various locations such as the surface of the ovaries, behind the uterus, on the outer part of the bladder, on the intestines, and in the space between the vagina and the rectum. Endometriotic lesions can cause significant pain through the substances they secrete and the inflammation they create.
  • Adenomyosis: This is a condition where the endometrial tissue is located within the muscle layer of the uterus. In addition to treatment-resistant bleeding, increasing menstrual pain may occur.
  • Fibroids: In this condition, where smooth muscle fibers forming the uterine muscle (myometrium) grow in a disorganized manner forming tumors, painful menstruation may occur depending on the location of the fibroid.
  • Intra-abdominal inflammatory conditions that lead to adhesions over time can also cause painful menstruation.
  • Uterine polyps: Polyps, which are small tissue growths inside the uterus, may cause painful menstruation.
  • Certain abnormalities of the uterus or vagina , such as obstructions that prevent menstrual blood flow, may cause painful menstruation.

When should I consult a doctor?

If;

  • The pain significantly affects quality of life
  • It is different from previous pain (more severe or different in nature, e.g., tearing sensation)
  • It lasts longer than 2 or 3 days
  • It does not respond to painkillers

If one or more of these conditions are present, a doctor should be consulted:

What diagnostic methods are used for painful menstruation?

First, details such as when the pain started, its nature, spread, whether it has increased, and whether it responds to medications should be explained before the examination. During the examination, the presence of the above-mentioned secondary causes is investigated. Ultrasonography is an important diagnostic tool for this purpose. It is especially useful for evaluating the uterine lining and detecting any abnormalities of the uterus. Blood and urine tests may be required to investigate inflammatory conditions. In some cases, laparoscopy may be necessary to determine the cause; this involves examining the abdominal cavity with an optical instrument under anesthesia after inflating it with gas.

How can I get rid of painful menstruation, what treatments are available?

First, it is important to determine whether there is an underlying cause of menstrual pain. If such a cause exists, it should be treated accordingly. For primary dysmenorrhea, heat applications (hot water bottle) may temporarily relieve pain. However, in modern treatment, painkillers (prostaglandin inhibitors, nonsteroidal anti-inflammatory drugs) are primarily recommended. If these are not effective, significant benefit can be obtained from birth control pills prescribed by physicians to suppress ovulation.

Painful menstruation, which significantly affects quality of life, should be taken seriously. It should be remembered that serious underlying conditions may exist, and a doctor should be consulted.

Wishing you healthy days…

 

Prof. Dr. Ümit İNCEBOZ / Obstetrics and Gynecology Specialist / İRENBE