When Period Pain Isn't Normal

By
Lara Briden
/
Women's Health
/
July 12, 2015

Do you suffer bad period pain? You shouldn’t have to. In fact, it might mean you have an underlying medical condition that needs attention. Let’s have a closer look. Just how much period pain is too much period pain?

Most women experience mild to moderate pain on occasion. This is the normal, run-of-the-mill period pain, and it’s called “primary dysmenorrhea”, which is the medical term for menstrual pain that is not caused by an underlying condition or disease.

Symptoms of normal primary dysmenorrhea:

●      Mild to moderate cramping pain in your lower pelvis or back

●      Pain that occurs the day before your period, or the first one to two days of your period

●      Pain that improves with one or two doses of ibuprofen

●      Pain that doesn’t interfere with your daily activities

●      Mild nausea or diarrhea

 Primary dysmenorrhea is caused by the release of prostaglandins in your uterus, and it often improves as you get older. It also responds extremely well to simple prostaglandin-lowering treatments such as ibuprofen, magnesium, and an anti-inflammatory whole food diet [1]. 

 There’s another kind of period pain. Not the run-of-the-mill, take-an-Advil kind of pain, but something much, much worse. This kind of period pain is called “secondary dysmenorrhea”, which is the term for menstrual pain that is caused by an underlying condition or disease.

 Symptoms of abnormal secondary dysmenorrhea:

●      Throbbing, burning, searing, or stabbing pain

●      Pain in your lower pelvis, back, or down your legs

●      Pain that lasts for three or more days

●      Pain that occurs for many days before your period

●      Pain that occurs after your period

●      Pain that occurs on other days (or all days) of your cycle

●      Pain that does not improve with a small dose (or any dose) of ibuprofen

●      Pain so bad you have to miss work or school

●      Pain so bad you vomit

●      Pain that is getting worse and worse as you get older

You simply should not have to suffer symptoms like this. If you have not already done so, please see your doctor, and explain to her just how bad your pain is. Try to quantify it by saying something like: “My pain is so bad that I take __ painkillers per day.” If your doctor dismisses your pain, then seek a second opinion.

Find a doctor who will do a physical exam, and maybe order blood tests and an imaging study called a pelvic ultrasound. With these investigations, your doctor can look for underlying conditions such as infection, uterine fibroids, adenomyosis, or endometriosis.

The most common reason for secondary dysmenorrhea is endometriosis.

What Is Endometriosis?

Endometriosis is a condition in which bits of endometrium (uterine lining) grow in places other than inside your uterus. These are called endometriosis lesions, and they are typically found on ovaries, Fallopian tubes, and on the outside of the bladder or bowel. Endometriosis lesions cause pain because they swell and bleed and become inflamed. We don't yet know exactly how endometrial tissue gets outside the uterus. We used to think it was from retrograde menstruation (back out through the Fallopian tubes), but experts now think that endometriosis tissue may be laid down before birth [2]. There is also some evidence that the inflammation of endometriosis has an autoimmune component [3].

Endometriosis is common, and affects up to 10% of women [4]. Pain is the main symptom, but there are other symptoms to watch for.

Symptoms of Endometriosis:

●      Severe period pain (see above)

●      Pain between periods

●      Daily pelvic pain

●      Pain with bowel movements (occurs when endometriosis grows on your intestine)

●      Deep stabbing pain with sex

●      Bleeding between periods

●      Menstrual clots larger than a quarter

●      Infertility 

A Missed Diagnosis 

Endometriosis typically takes up to ten years to diagnose because many doctors mistakenly believe that endometriosis does not occur in young women. In reality, endometriosis often starts in the teen years, and one study found that up to 70% of teens reporting chronic pelvic pain will eventually go on to be diagnosed with endometriosis [5]. 

Don’t let that happen to you. Don’t suffer a decade of crippling pain and be told that it’s “just period pain”, and there’s nothing you can do about it.

Speak to your doctor. Ask her outright if it could be endometriosis. Have a conversation and explore your options. Your doctor may recommend laparoscopic or keyhole surgery, which sounds scary at first, but at present time it is often the only way to definitively diagnose and treat endometriosis. Surgery is something you should at least consider, because early excision has been shown to eradicate the disease in some cases [6]. Even when it isn’t a cure, surgery can significantly reduce pain and inflammation, which will give you an opportunity to find other pharmaceutical or natural treatments. 

References:

1. Barnard ND et al. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstet Gynecol. 2000 Feb;95(2):245-50. PMID: 10674588

2. Signorile PG et al. Ectopic endometrium in human foetuses is a common event and sustains the theory of müllerianosis in the pathogenesis of endometriosis, a disease that predisposes to cancer. J Exp Clin Cancer Res. 2009;28:49. PMID: 19358700

3. Eisenberg VH et al. Is there an association between autoimmunity and endometriosis? Autoimmun Rev. 2012;11(11):806-14. PMID: 22330229

4. Bulletti C et al. Endometriosis and infertility. J Assist Reprod Genet. 2010 Aug;27(8):441-7. PMID: 20574791

5. Janssen EB et al. Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Hum Reprod Update. 2013;19(5):570-82. PMID: 23727940

6. Yeung P Jr et al. Complete laparoscopic excision of endometriosis in teenagers: is postoperative hormonal suppression necessary? Fertil Steril. 201;95(6):1909-12. PMID: 21420081

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