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Painful periods: Causes, treatment and when to seek medical help

Are your periods really painful and make you want to stop working and just lie down for all those days? Let’s look at some of the causes of painful periods and also what you can do about them.

Every woman’s story? 

My ordeal with painful periods started at 15, a couple of years after I began menstruating. A younger cousin, a close friend, an aunt – women all around seemed to experience debilitating pain during periods in varying degrees. This propagated the myth that painful periods were normal. 

It took another 17 years and an unnecessary appendectomy for me to get a conclusive diagnosis for endometriosis. The cousin and the friend were both diagnosed with PCOS in their late 20s. The aunt had uterine fibroids. 

The lesson from these experiences is that dysmenorrhea – excessive pain during periods – is not natural or normal, and is almost always triggered by underlying medical factors. 

Yes, most women experience some degree of pain, cramping, and discomfort such as bloating or nausea before or during periods. However, if the pain is so acute that it interferes with your ability to perform day-to-day tasks, it’s a cause for concern and indicates an underlying problem. 

What are these causes and what can be done to alleviate the discomfort? Let’s take a closer look at dysmenorrhea to understand. 

What is Dysmenorrhea? 

Dysmenorrhea is the medical term for pain and discomfort associated with menstruation. More than half of the women experience dysmenorrhea, especially during the first day or two of the period. If the pain is minimal and bearable, it is considered normal. However, for some women dysmenorrhea takes on an acute form, rendering them incapable of performing even the most basic tasks and activities. 

Based on the degree of discomfort and pain, dysmenorrhea is divided into two types: 

  • Primary Dysmenorrhea: This refers to minimal cramping and pain that women experience just before or during the first couple of days of their period. Primary dysmenorrhea is triggered by prostaglandins, which are natural chemicals produced in the uterus lining and cause the uterine muscles and blood vessels to contract. This process helps the uterus shed the endometrial lining, which is what causes you to bleed. As your period progresses, the prostaglandins levels begin to reduce and the pain begins to lessen.  
  • Secondary Dysmenorrhea: This type of period pain is caused due to certain medical conditions or disorders in the reproductive organs. The pain is a lot more severe than normal menstrual cramps and lasts longer. For instance, for some women, the pain may start days before their period begins and may worsen as the period progresses. It may also be accompanied by other symptoms such as migraines, diarrhoea, vomiting, extreme soreness in breasts. Secondary dysmenorrhea is also characterised by pain that travels from the lower abdomen to the back and radiates to the thighs. 

What causes extreme pain during periods? 

As we mentioned before, secondary dysmenorrhea or extremely severe pain during periods is caused by underlying medical conditions or disorders. Some of the most causes include: 

  • Endometriosis: Endometriosis is one of the leading causes of painful periods. In this extremely painful condition, cells from the uterus lining start to grow in other parts of the body – most commonly the ovaries, fallopian tubes or the pelvis tissue lining, enhancing the severity of menstrual cramping and pain. Women with endometriosis also experience other symptoms such as excessive bloating, poor digestion or diarrhoea, migraines and nausea during periods. 
  • Premenstrual Syndrome (PMS): Premenstrual Syndrome or PMS is a common condition caused by hormonal changes in the body before the periods, which can enhance the severity of menstrual cramps. It is also characterised by mood swings and intense sugar cravings. 
  • Uterine Fibroids: Fibroids are benign (non-cancerous) tumours in the uterus that can lead to abnormal pain during menstruation due to the excess pressure being exerted by these unnatural growths. 
  • Pelvic Inflammatory Disease: Pelvic inflammatory disease (PID) is an infection in the reproductive organs such as the uterus, ovaries or fallopian tubes caused due to sexually transmitted bacteria. PID results in inflammation in these organs, resulting in increased discomfort during periods. 
  • Adenomyosis: A rare condition characterised by uterine lining growing into the muscular walls of the uterus, Adenomyosis also causes pressure, inflammation and pain. It is also associated with heavier, severely painful periods. 
  • Cervical Stenosis: Cervical stenosis is also a rare medical condition where the cervical opening is so narrow that it inhibits the flow of blood during menstruation, causing pressure and pain inside the uterus. 
  • Copper IUD: Contraception methods such as a copper IUD can also make periods more painful and heavier. If the underlying cause is the IUD, you will experience an increase in pain and blood flow from the next cycle after the insertion and the pattern may repeat for a few months. However, if you have had a copper IUD in place for years but have begun experiencing painful periods only recently, the cause could be something else altogether. 
  • Polycystic Ovary Syndrome: Polycystic ovary syndrome or PCOS can either cause women to miss periods, resulting in fewer than 8 menstrual cycles in a year, or make periods more frequent, with cycles of 21 days or less. In both cases, bleeding results in acute abdominal cramping and pain. 

In addition to these medical conditions, the degree of pain during periods is also influenced by factors such as: 

  • Reaching puberty before the age of 11 
  • Being under the age of 20 
  • Smoking 
  • Family history of painful periods 
  • Irregular periods 
  • No childbirth 

Treatment for painful periods 

The course of treatment for painful periods depends on the factors causing them. Some of the common treatment options your ob/gyn may recommend, include: 

  • Pain Killers: Over-the-counter pain relievers such as ibuprofen, naproxen sodium or acetaminophen may be prescribed for managing pain during periods. 
  • Hormonal Birth Control: Hormone-based contraceptives such as oral birth control pills, injections, implants or IUDs, may be used to regulate ovulation and manage the severity of period pain in certain conditions. 
  • Surgery: In the case of conditions like fibroids or endometriosis, surgical procedures may be performed to alleviate the symptoms. 

Home remedies for painful periods 

In addition to these treatment options, you can also try some home remedies for relief from pain. Some of the time-tested remedies are: 

  • Use a heating pad or hot water bottle on the affected area to soothe the cramps and alleviate pain.
  • Massage the affected area with essential oils such as rosemary, marjoram, lavender or clary sage for about 20 minutes for pain relief 
  • Avoid caffeine, carbonated drinks, salty and fatty foods and alcohol during your periods 
  • Drink water infused with carom seeds and fennel seeds for relief from gas and bloating during menstruation, which can amplify the pain. 
  • Stay hydrated and focus on enhancing your fluid intake 
  • An orgasm can bring instant and immense relief from pain. If you’re sexually active, have sex with your partner. Otherwise, you can consider masturbating 
  • Exercise helps with hormone regulation, which can directly impact the severity of pain during periods. Even if you’re unable to exercise during your period, try to maintain a regular workout regimen for the rest of the month

Painful periods can adversely impact your quality of life. Know that crippling pain during menstruation is not normal, and it is not something you have to put up with. If you’re struggling with it, consult your ob/gyn and consciously work toward making lifestyle changes such as exercising, eating healthy, cutting back on alcohol intake and quitting smoking that can help reduce the intensity of pain. 

To protect the identity, the person in the picture is a model. 

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Arushi Chaudhary is a freelance journalist and writer with 5 years of experience in print publications such as the Pune Mirror and Hindustan Times, and has spent close to a decade writing for digital platforms and print publications – The Tribune, BR International magazine, Make My Trip, Killer Features, The Money Times, and Home Review, to name a few. Of the many things she's written about over the years, exploring the space of love and relationships through the prism of psychology excites her the most. Writing is her first and forever love. You can find her on Twitter here.

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