Many women have pain with their periods, especially when they are in their teens age years. In most cases, menstrual pain does not indicate a serious problem, although sometimes it can be associated with noncancerous tumors in the uterus, including endometriosis or uterine fibroids.
The medical term for menstrual pain is primary dysmenorrhea. Primary dysmenorrhea usually starts shortly after the first period, as a woman begins to ovulate regularly. Pain usually starts a day or two before menstrual flow, and may continue through the first 2 days of the period. Often, pain gets better as a woman gets older, or after she has a child. Dysmenorrhea is twice as common among women with irritable bowel syndrome (IBS) compared to those who do not have IBS.
Secondary dysmenorrhea is caused by underlying conditions, such as endometriosis and pelvic inflammatory disease (PID).
Symptoms and degree of pain vary, and may include the following:
Primary dysmenorrhea is caused by strong contractions of the uterus triggered by prostaglandins, chemicals in the body that are involved in inflammation and pain. Generally, the higher the levels of prostaglandins, the more menstrual pain.
Secondary dysmenorrhea can be caused by:
A pelvic examination may include an internal examination, laparoscopy, and ultrasound. You may need a Pap test. Your doctor may also ask for blood and urine samples.
Initial treatment is focused on relieving pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs help relieve pain. They can cause stomach upset, so taking them with food may help. Long-term use can increase the risk of stomach bleeding. NSAIDs include over-the-counter (OTC) medications such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Aleve). Prescription NSAIDs are also available.
Cyclooxygenase-2 (COX-2) inhibitors. Help relieve pain and have fewer gastrointestinal side effects than NSAIDs.
Birth control pills and patches. Can help relieve pain and may be prescribed for problems such as endometriosis.
Intrauterine devices. Reduce menstrual bleeding and dysmenorrhea.
For menstrual pain results caused by pelvic inflammatory disease (PID), your doctor will prescribe antibiotics.
Some women find that changing their diets makes cramps less severe. Mind-body techniques such as meditation and acupuncture, and exercises such as yoga and tai chi, can also help relieve pain. Aromatic essential oils and massage may also help relieve pain.
Nutrition and Supplements
Some studies also suggest following a gluten-free diet helped reduce painful symptoms of endometriosis.
The following supplements may also help relieve menstrual pain:
Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, tinctures, or liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage.
Some researchers think the following herbs act like estrogen in the body. Women who have a history of hormone-related cancer, who are taking hormone replacement therapy, or who have a bleeding disorder or are taking blood-thinning medication should ask their doctor before taking these herbs:
Few studies have examined the effectiveness of specific homeopathic remedies. However, a professional homeopath may recommend one or more of the following treatments for menstrual pain based on his or her knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
The following methods may help relieve pelvic pain:
Acupuncture has become a popular treatment for menstrual pain. The National Institutes of Health recommends acupuncture, either by itself or along with other treatments, for menstrual pain. In a well-designed study of 43 women with menstrual pain, women treated with acupuncture had less pain and needed less pain medication.
Acupuncturists treat people with dysmenorrhea based on an individualized assessment of the excesses and deficiencies of energy (called qi) located in various meridians. In the case of dysmenorrhea, a qi deficiency is usually detected in the liver and spleen meridians. Moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points) is often added to enhance needling treatment, and qualified practitioners may also recommend herbal or dietary treatments.
Acupressure also works to relieve pain. A study of 216 female students found that acupressure and ibuprofen were better than placebo at reducing pain.
Some people with menstrual pain may find relief with spinal manipulation, particularly in areas that supply sensory and motor impulses to the uterus and lower back.
If your symptoms change, or treatment does not help, tell your provider.
Avoid caffeine, alcohol, and sugar before your period starts.
Balbi C, Musone R, Menditto A, et al., Influence of menstrual factors and dietary habits on menstrual pain in adolescence age. Eur J Obstet Gynecol Reprod Biol. 2000;91(2):143-8.
Barnard ND, Scialli AR, Hurlock D, Bertron P. Diet and sex-hormone binding globulin, dysmenorrhea, and premenstrual symptoms. Obstet Gynecol. 2000;95(2):245-50.
Bernstein MT, Graff LA, Avery L, Palatnick C, Parnerowski K, Targownik LE. Gastrointestinal symptoms before and during menses in healthy women. BMC Womens Health. 2014;14:14.
Bope & Kellerman: Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.
Chen YW, Wang HH. The effectiveness of acupressure on relieving pain: a systematic review. Pain Manag Nurs. 2014;15(2):539-50.
Dennehy CE. The use of herbs and dietary supplements in gynecology: an evidence-based review. J Midwifery Womens Health. 2006;51(6):402-9.
Ferri: Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier; 2016.
Fjerbaek A, Knudsen UB. Endometriosis, dysmenorrhea and diet -- what is the evidence? Eur J Obstet Gynecol Reprod Biol. 2007;132(2):140-7.
Ghodsi Z, Asltoghiri M. The effect of fennel on pain quality, symptoms, and menstrual duration in primary dysmenorrhea. J Pediatr Adolesc Gynecol. 2014;27(5):283-6.
Grimes DA, Hubacher D, Lopez LM, Schulz KF. Non-steroidal anti-inflammatory drugs for heavy bleeding or pain associated with intrauterine-device use. Cochrane Database Syst Rev. 2006;(4):CD006034.
Guerrera MP, Volpe SL, Mao JJ. Therapeutic uses of magnesium. Am Fam Physician. 2009 Jul 15;80(2):157-62. Review.
Habek D, Cortez Habek J, Bobic-Vukovic M, Vujic B. Efficacy of acupuncture for the treatment of primary dysmenorrheal. Gynakol Geburtshilfliche Rundsch. 2003 Oct;43(4):250-3.
Keogh E, Cavill R, Moore DJ, Eccleston C. The effects of menstrual-related pain on attentional interference. Pain. 2014;155(4):821-7.
Lentz: Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012.
Letzel H, Megard Y, Lamarca R, Raber A, Fortea J. The efficacy and safety of aceclofenac versus placebo and naproxen in women with primary dysmenorrhoea. Eur J Obstet Gynecol Reprod Biol. 2006;129(2):162-8.
Liu CZ, Xie JP, Wang LP, et al. Immediate analgesia effect of single point acupuncture in primary dysmenorrhea: a randomized controlled trial. Pain Med. 2011 Feb;12(2):300-7. doi: 10.1111/j.1526-4637.2010.01017.x. Epub 2010 Dec 17. Erratum in: Pain Med. 2011 Apr;12(4):685.
Lloyd KB, Hornsby LB. Complementary and alternative medications for women's health issues. Nutr Clin Pract. 2009 Oct-Nov;24(5):589-608.
Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012;67(7):499-504.
Mirbagher-Ajorpaz N, Adib-Hajbaghery M, Mosaebi F. The effects of acupressure on primary dysmenorrhea: a randomized controlled trial. Complement Ther Clin Pract. 2011 Feb;17(1):33-6.
Nagata C, Hirokawa K, Shimizu N, Shimizu H. Associations of menstrual pain with intakes of soy, fat and dietary fiber in Japanese women. Eur J Clin Nutr. 2005;59(1):88-92.
Ou MC, Hsu TF, Lai AC, Lin YT, Lin CC. Pain relief assessment by aromatic essential oil massage on outpatients wit hprimary dysmenorrhea: a randomized, double-blind clinical trial. J Obstet Gynaecol Res. 2012;38(5):817-22.
Pouresmail Z, Ibrahimzadeh R. Effects of acupressure and ibuprofen on the severity of dysmenorrheal. J Tradit Chin Med. 2002 Sep;22(3):205-10.
Proctor ML, Murphy PA, Pattison HM, Suckling J, Farquhar CM. Behavioural interventions for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2007;(3):CD002248.
Proctor ML, Hing W, Johnson TC, Murphy PA. Spinal manipulation for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2006;3:CD002119.
Proctor ML, Latthe PM, Farquhar CM, Khan KS, Johnson NP. Surgical interruption of pelvic nerve pathways for primary and secondary dysmenorrhea. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD001896.
Tugay N, Akbayrak T, Demirturk F, et al. Effectiveness of transcutaneous electrical nerve stimulation and interferential current in primary dysmenorrhea. Pain Med. 2007;8(4):295-300.
Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD002120. Review.
Ye R, Wang S, Li Y, et al. Primary dysmenorrhea is potentially predictive for initial orthodontic pain in female patients. Angle Orthod. 2014;84(3):424-9.
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
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