Dysmenorrhea (period pain)

Dysmenorrhea is the medical term for period pain. You may get cramps or other discomforts before or during your period. Over 50% of women experience menstruation-related pain for 1-2 days per month. Some women have such severe pain that it stops them from doing daily activities for a few days. There are 2 different kinds of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea. 

This article has been verified by a medical professional

Primary dysmenorrhea is cramping caused by the body’s own production of prostaglandins. These are chemicals produced by your uterine lining which build up over the course of your cycle and make your uterus contract. The pain tends to be the strongest on the first day you start bleeding and goes down as you shed your uterine lining through menstruation. Some cycles may be more or less painful than others.

Secondary dysmenorrhea is when painful periods are due to a reproductive health condition which may also be impacting fertility.

Potential causes of secondary dysmenorrhea

Painful periods can be a symptom of the following conditions:

• Endometriosis (a common condition where tissue similar to the uterine lining grows in other areas)
• Adenomyosis (when tissue that normally lines the uterus grows on the muscular wall of the uterus)
• Uterine fibroids (non-cancerous growths on the uterus)
• Pelvic inflammatory disease (an infection caused by bacteria such as chlamydia or gonorrhea)
• Uterine polyps (growths inside the uterine cavity)
• Cervical stenosis (narrowing or closure of the cervix)

Pain from secondary dysmenorrhea typically begins earlier in the cycle and lasts longer than common cramps.

Impact of dysmenorrhea on fertility

Primary dysmenorrhea doesn’t affect fertility. Secondary dysmenorrhea, on the other hand, is a symptom of another condition which could be making it more difficult for you to get pregnant.

For instance, endometriosis (the most common cause of secondary dysmenorrhea) can damage and scar the ovaries and fallopian tubes, which blocks the movement of sperm and eggs and can stop a fertilized egg from reaching the uterus. Endometriosis can also reduce the quality of your eggs and alter your pelvic anatomy.

Uterine fibroids and polyps can change the shape of the uterus, block a fertilized egg from implanting, and increase the risk for miscarriage. Polyps may also cause inflammation in the womb which interferes with implantation and normal development of the embryo.

Pelvic inflammatory disease (PID) can lead to permanent scarring on the fallopian tubes, preventing sperm from reaching an egg and a fertilized egg from getting to the uterus. PID can also cause fallopian tubes to become swollen and filled with fluid (called a hydrosalpinx). These increase the probability of an ectopic pregnancy six-fold.

Cervical stenosis can prevent sperm from entering the uterus and complicate fertility treatments including intrauterine insemination (IUI) and in vitro fertilization (IVF).

Symptoms of dysmenorrhea

The most common sign of dysmenorrhea is cramping. Other signs of period pain can include:

• Pain in the lower back, hips, and inner thighs
• Diarrhea
• Nausea
• Vomiting
• Headache
• Dizziness

Diagnosis of dysmenorrhea

To find out if you have primary or secondary dysmenorrhea, you should get diagnostic tests and discuss any other symptoms you’re experiencing with your healthcare provider. Tests to look for the cause of dysmenorrhea may include:

• Pelvic exam
• Vaginal swab test
• Urine and blood tests
• Ultrasound
• Laparoscopy

Treatment for secondary dysmenorrhea to improve fertility

If your doctor finds that you have a health condition such as endometriosis or fibroids that are causing you to have severe period pain, you can start on a treatment plan to improve both your symptoms as well as your fertility.
For endometriosis, surgical operations can destroy or remove endometrial tissue, scarring, and ovarian cysts to help with pain and improve the chances of getting pregnant. Evidence shows that surgery helps almost 40% of infertile women with endometriosis get pregnant within 2 years. Read more about endometriosis and treatments in our factsheet and blog article.

Treatment for fibroids can include surgery, medication, non-invasive treatments, and interventional radiology and is decided on a case-by-case basis. Research shows that when submucosal fibroids are surgically removed before getting pregnant, women have higher rates of pregnancy and delivery, particularly when fibroids are the only thing reducing fertility. Read more about the types of fibroids and treatment in our blog article.

Medication and surgery can also be used to treat polyps. Studies find that surgical removal of polyps can significantly improve pregnancy rates in women who conceive naturally as well as those who use IUI to get pregnant.

PID is treated with antibiotics, but that unfortunately can’t reverse scarring to the fallopian tubes. Surgery can help clear blockages in fallopian tubes and improve the chances of conceiving naturally. If the tubes are too damaged, in vitro fertilization (IVF) is a good option to get pregnant. A hydrosalpinx may need to be removed or separated from the womb to raise the probability of IVF success.

Finally, cervical stenosis is treated through dilation (widening) of the cervix. Small, lubricated metal rods get inserted through the cervical opening, progressively increasing in size. A doctor may place a tube in the cervix and leave it in place for several weeks to keep the cervix open.

Besides treating the cause of secondary dysmenorrhea, here are several ways to relieve pain from cramps:

• Take a nonsteroidal anti-inflammatory drug such as ibuprofen or aspirin
• Place a heating pad or hot water bottle on your tummy or under your lower back
• Avoid caffeine, smoking, and drinking alcohol
• Inhale essential oils or rub them on your tummy (lavender, sage, rose, marjoram, cinnamon, and clove are the most effective)
• Get some exercise
• Take a hot bath
• Do some gentle yoga
• Take a magnesium supplement
• Drink enough water (8 glasses/day)

This article has been verified by a medical professional

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