Dysmenorrhoea (Painful Periods)

Dysmenorrhoea refers to pain during menstruation, most often felt as cramping in the lower abdomen, and is one of the most common gynaecological complaints among women of reproductive age. It is classified as primary dysmenorrhoea, which is not caused by another condition and usually begins soon after periods start in adolescence, or secondary dysmenorrhoea, which develops later in life and is caused by an underlying condition such as endometriosis or uterine fibroids. Mild period pain is extremely common and often manageable at home, but pain severe enough to disrupt school, work, or daily life is not something to simply endure, and can be effectively treated once properly evaluated.

• Cramping or throbbing pain in the lower abdomen, typically starting just before or at the onset of bleeding and lasting one to three days • Pain that may radiate to the lower back or thighs • Nausea, vomiting, diarrhoea, or fatigue accompanying the pain • Headache during menstruation Features suggesting secondary dysmenorrhoea (an underlying cause) rather than primary: • Pain that starts later in life, after years of relatively pain-free periods • Pain that progressively worsens over time rather than staying stable • Pain that continues beyond the first few days of the period, or occurs outside menstruation • Pain associated with heavy bleeding, pain during sex, or difficulty conceiving

Primary dysmenorrhoea is caused by prostaglandins, hormone-like substances released by the uterine lining during menstruation that cause the uterine muscle to contract; higher prostaglandin levels are associated with more severe cramping, reduced blood flow to the uterus, and the accompanying nausea and headache some women experience. Secondary dysmenorrhoea results from an underlying gynaecological condition, most commonly endometriosis or uterine fibroids, but also including adenomyosis, pelvic inflammatory disease, or, less commonly, an intrauterine device (IUD).

• Age under 20, and periods that started before age 12 • Heavy or prolonged menstrual bleeding • Family history of painful periods • Smoking • Never having given birth • For secondary dysmenorrhoea: underlying conditions such as endometriosis, fibroids, or adenomyosis

• Significant disruption to school, work, and daily activities during menstruation each month • Missed school or work days, with downstream academic or occupational impact • When caused by an underlying condition (secondary dysmenorrhoea), the complications of that condition itself, such as the fertility impact of untreated endometriosis

Primary dysmenorrhoea cannot always be prevented, but symptoms can be significantly reduced: • Regular exercise has been shown to reduce the severity of menstrual cramps • NSAIDs (such as ibuprofen), started a day before the period is expected and continued through the first days of bleeding, work by reducing prostaglandin production • Heat application to the lower abdomen provides effective symptomatic relief • Hormonal contraceptives reduce prostaglandin production and are effective for women who also desire contraception For secondary dysmenorrhoea, treating the underlying cause (such as endometriosis or fibroids) is necessary for lasting relief.