Menstrual Pain

For most women, menstruation comes and goes each month with ease. But for others, or at various times in a woman's childbearing years, periods may be complicated by pain. The medical term for menstrual pain is dysmenorrhea.

Causes

Dysmenorrhea without a clear medical cause is referred to as primary dysmenorrhea. One such type of painful period seems to run in families. Researchers in the 1970s and 1980s discovered higher than average levels of prostaglandins -- fatty acids in the body that act much like hormones -- in the menstrual fluid of women who suffered from cramps. Prostaglandins serve many functions in the body, but too much of them can cause cramplike pain from uterine irritability or contractions.

Other types of painful periods (secondary dysmenorrhea) may be caused by fibroids (noncancerous growths) in the uterus, infection or endometriosis. Intrauterine contraceptive devices (IUDs) may also cause pain during menstruation. If your periods become more painful or begin to last longer than they used to, see your doctor.

Symptoms

Menstrual pain usually involves a crampy feeling in the lower abdomen. It sometimes spreads to the hips, lower back and thighs. It may be accompanied by diarrhea, nausea and headaches. It is more common in women ages 15 to 24 and among women who have not given birth.

Self-Care

• Use aspirin, ibuprofen or prescription pain relievers. Aspirin usually relieves mild to moderate menstrual pain. Ibuprofen (Advil, Motrin) is the medication of choice. If you do not get enough relief from these over-the-counter medications, your doctor may be able to prescribe a higher dose of ibuprofen or a prescription nonsteroidal anti-inflammatory drug (NSAID). For maximum relief you should start taking an NSAID such as ibuprofen three days before you expect your period to start and continue it through the first two to three days of your period. 

• Apply heat. A heating pad or hot-water bottle placed on the lower abdomen will ease the pain. You can also take a warm bath for 20 to 30 minutes.

• Raise your hips. If you find yourself in bed because of cramps, try lying on your back with your hips elevated above the level of your shoulders. Put your feet up on the footboard of the bed or the arm of the couch and place pillows under your hips. Firm massaging of the lower back may also help.

• Maintain adequate fluid intake.

• It is always important to get adequate rest. If you are tired, you are less able to tolerate pain, and cramps may seem worse.

• Call your doctor if menstrual cramps are not relieved by home care after two cycles.

Decision Guide for Mestrual Pain
Signs/Symptoms and Action you should take:

• Painful periods or cramps that can be relieved - use self-care
• Pain during period is worse than it used to be and possible exposure to a sexually transmitted disease (STD) - call provider's office
• Pain increases and is accompanied by fever and blistery rash on your body - see provider
• Very heavy bleeding (soaking one or more pads per hour for more than 4 hours, or one or more pads every 15 minutes for more than one hour) - seek help now