Menstruation, painful

Alternative names:

cramps, menstrual; dysmenorrhea; painful menstrual periods; periods, menstrual - painful

Home care:

Ibuprofen or acetaminophen may relieve mild menstrual pain. Antiprostaglandins are quite effective in the management of moderate to more severe pain. These include higher doses of aspirin, as directed by a health care provider. However, this is sometimes hard for patients to tolerate. Other nonsteroidal anti-inflammatories may be used; ibuprofen is the most common. To work effectively, these medications must be taken at the first appearance of symptoms. Some women experience several days of pain which may require the use of narcotic pain relievers such as codeine.

Some relief may be provided by applying a heating pad to the abdomen, effleurage (a light circular massage with the fingertips), drinking warm beverages, taking a warm shower, performing waist-bending and pelvic rocking exercises, and walking.

Emotional support, psychological counseling, or antidepressants may be helpful for those women who have inadequate relief of chronic pain.

If pain continues, consult your health care provider.

Call your health care provider if:

• the pain is severe.
• menstrual periods always hurt, or if other unexplained symptoms accompany the pain.

What to expect at your health care provider's office:

The medical history will be obtained and a physical examination performed.

Medical history questions documenting your symptom in detail may include:

• menstrual history
  • Are you a woman presently in a menstruating age?
  • Are you sexually active?
  • Do you use birth control? What type?

• quality
  • Was the previous menstrual period a normal amount?
  • Do you use tampons with menstruation?
  • Do you normally have regular periods?
  • Do you have heavy menstrual bleeding (menorrhagia)?
    • With passage of blood clots?

  • Do you have prolonged menstrual bleeding (more than five days per menstrual period)?
  • Describe the pain (sharp, dull, intermittent, constant, aching, cramping).

• time pattern
  • When was the last menstrual period?
  • What was the age at which you had your first menstrual period?
  • How long have you had the same menses pattern?
  • When did you begin to have painful menstruation?
  • Is it getting worse or better?
  • When in your menstrual cycle do you experience the pain?

• relieving factors
  • What have you done to try to relieve the discomfort?
    • How effective was it?

  • What has been effective in the past for you?

• other
  • What other symptoms are also present?

The physical examination will probably include a pelvic examination.

Diagnostic tests that may be performed include:

• dilation of the cervix (see D&C procedure)
• laparoscopy
• cultures (may be taken to rule out sexually transmitted diseases such as gonorrhea, primary syphilis, or Chlamydia infections)
• CBC
• sed rate
• RPR

Intervention:

• Oral contraceptives may be prescribed as an attempt to alleviate menstrual pain. If not needed for contraception, they may be discontinued after 6 to 12 months. Many women note continued freedom from symptoms despite stopping the medication.
• Surgery may be indicated for those women unable to obtain adequate pain relief or control. Procedures may range from removal of cysts, polyps, adhesions, or fibroids to complete hysterectomy in cases of extreme endometriosis.
• Prescription medications may be used for endometriosis.
• For pain caused by IUD, removal of the IUD and alternative birth control methods may be needed.
• Antibiotics may be indicated for pelvic inflammatory disease.

After seeing your health care provider:
You may want to add a diagnosis related to painful menstruation to your personal medical record.