Dysmenorrhea Meaning: Causes, Severity & Treatment

Painful periods are common, but severe or persistent menstrual pain should not always be accepted as a normal part of having a period. The medical term for painful menstruation is dysmenorrhoea. It usually causes cramping or pain in the lower abdomen and may also be associated with back pain, nausea, diarrhoea or fatigue.

This guide explains the meaning of dysmenorrhoea, the difference between primary and secondary dysmenorrhoea, common causes, how severity is assessed and the treatment options available.

Dysmenorrhoea is the medical term for painful periods. The pain usually occurs shortly before or during menstruation and may range from mild cramping to pain that interferes with daily activities.

During menstruation, the uterus contracts to help shed its lining. These contractions are influenced by substances called prostaglandins. Higher prostaglandin activity can cause stronger uterine contractions and contribute to menstrual pain.

Mild cramping during the first few days of a period is common. However, pain that regularly interferes with work, education, sleep, exercise or other daily activities deserves medical attention, particularly if it is becoming more severe or changing over time.

Dysmenorrhoea is broadly classified as primary or secondary depending on whether there is an underlying pelvic condition.

Primary Dysmenorrhoea

Primary dysmenorrhoea refers to painful periods that are not caused by an identifiable pelvic disease. It is commonly associated with increased prostaglandin activity and stronger uterine contractions.

The pain usually begins around the start of menstruation and may last for a few days. It often improves as menstrual bleeding becomes lighter.

Secondary Dysmenorrhoea

Secondary dysmenorrhoea occurs because of an underlying condition affecting the reproductive organs. The pain may develop later in life, become progressively worse or occur at other times in the menstrual cycle.

Features that may suggest secondary dysmenorrhoea include:

• Pain that is becoming progressively worse
• Pain that begins several days before menstruation or continues after the period
• Pelvic pain at other times of the menstrual cycle
• Pain during sexual intercourse
• Heavy or irregular menstrual bleeding
• Difficulty becoming pregnant
• Unusual vaginal discharge or fever

A gynaecological assessment can help identify the underlying cause and guide treatment.

The causes of menstrual pain depend on whether the dysmenorrhoea is primary or secondary.

Common causes include:

• Primary dysmenorrhoea: Increased prostaglandin activity causes stronger uterine contractions and menstrual cramping.
• Endometriosis: Tissue similar to the lining of the uterus grows outside the uterus and can cause pelvic pain, painful periods and pain during sex.
• Adenomyosis: Tissue similar to the uterine lining grows into the muscular wall of the uterus and may cause painful periods, heavy bleeding and an enlarged or tender uterus.
• Uterine fibroids: These are non-cancerous growths in or around the uterus that can contribute to heavy bleeding and menstrual pain.
• Pelvic inflammatory disease: Infection of the reproductive organs can cause pelvic pain and may be associated with abnormal vaginal discharge or fever.
• Copper intrauterine device: A copper IUD can increase menstrual bleeding and cramping, particularly during the first few months after insertion.

If period pain is becoming more severe, occurs outside menstruation or is accompanied by other symptoms, speak with a gynaecologist to identify the cause.

There is no single pain level that defines dysmenorrhoea. Healthcare professionals consider the intensity of pain as well as how much it affects daily activities.

Your doctor may also ask when the pain starts, how long it lasts, whether it spreads to your back or thighs and whether you experience symptoms such as nausea, vomiting, diarrhoea or dizziness.

Keeping a menstrual and pain diary can be useful. Record when the pain begins, how severe it is, how long it lasts, how it affects your activities and what provides relief.

Treatment depends on the severity of the pain, whether it is primary or secondary dysmenorrhoea and your overall health.

NSAIDs for Menstrual Pain

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, can reduce menstrual pain by lowering prostaglandin production. They tend to work best when started at the beginning of the pain or, for predictable cycles, shortly before menstruation begins.

Take NSAIDs only as directed on the product label or by your healthcare professional. They are not suitable for everyone, particularly people with certain stomach, kidney, bleeding or cardiovascular conditions.

If you are looking for products intended for menstrual cramp relief, you can explore the Cramp Relief range available through Apollo Pharmacy. Check the individual product information and speak with your pharmacist or doctor if you are unsure whether a product is suitable for you.

Heat Therapy

Applying a warm, not hot, compress or heat pad to the lower abdomen can help reduce menstrual cramps. Use a comfortable temperature and avoid prolonged direct contact with the skin.

Physical Activity and Lifestyle Measures

Regular physical activity may help reduce menstrual pain for some women. Gentle exercise such as walking, cycling or stretching can also help you stay active during your period if you feel comfortable.

Adequate sleep and a balanced diet support overall health. Some evidence suggests that dietary patterns containing adequate omega-3 fatty acids may help reduce menstrual pain, although diet alone is not a treatment for severe dysmenorrhoea.

Hormonal Treatments

Hormonal contraceptives can reduce menstrual pain by suppressing ovulation and reducing the growth of the uterine lining. Options may include combined hormonal contraceptives, progestogen-only methods or a levonorgestrel-releasing intrauterine system.

These treatments require an individual assessment because they are not suitable for everyone. Your gynaecologist can discuss the benefits, risks and most appropriate option based on your medical history and contraceptive needs.

When dysmenorrhoea is caused by an underlying condition such as endometriosis, adenomyosis, fibroids or pelvic inflammatory disease, treatment is directed at the underlying condition.

Painkillers and hormonal treatments are not suitable for everyone. Before taking a medicine for menstrual pain, tell your doctor or pharmacist if you:

• Have had a stomach ulcer or gastrointestinal bleeding
• Have kidney, liver or heart disease
• Have a bleeding disorder
• Take anticoagulants or other medicines that affect blood clotting
• Have had an allergic reaction or asthma symptoms after taking aspirin or another NSAID
• Could be pregnant or are trying to conceive
• Take other medicines regularly

Do not take more than the recommended dose of any painkiller or combine different NSAIDs unless advised by a healthcare professional.

Hormonal treatments also have specific contraindications and precautions that vary according to the type of treatment. Your doctor will review your medical history before prescribing them.

If you experience a suspected side effect from a medicine, inform your healthcare professional and report it through the appropriate adverse drug reaction reporting system.

Speak with a doctor if:

• Period pain regularly interferes with your daily activities
• Pain is becoming more severe or is different from your usual menstrual pain
• Pain continues after your period ends or occurs between periods
• Pain develops during sexual intercourse
• You have very heavy or irregular menstrual bleeding
• You have difficulty becoming pregnant
• You have unusual vaginal discharge or fever with pelvic pain
• Pain does not improve with appropriate over-the-counter treatment

Seek urgent medical attention for sudden, severe pelvic pain, particularly if it is accompanied by fainting, dizziness, heavy bleeding or a possible pregnancy.

A gynaecological assessment may include a medical history, physical examination, pregnancy test, blood tests or ultrasound depending on your symptoms.

Dysmenorrhoea means painful menstruation and can range from mild cramps to pain that significantly affects daily life. Primary dysmenorrhoea is usually related to prostaglandin-driven uterine contractions, while secondary dysmenorrhoea occurs because of an underlying condition such as endometriosis, adenomyosis or fibroids.

Menstrual pain that is severe, worsening, occurs outside your period or is accompanied by heavy bleeding, unusual discharge, or other symptoms should be assessed by a healthcare professional. Identifying the cause can help you receive appropriate treatment and avoid having to live with persistent period pain.