By Dr. Arpine Davtyan, pediatric resident at CHOC
Heavy periods, also known as dysmenorrhea, can be painful, and is one of the most common medical problems teen girls face. More than 60 percent of teenage girls report painful periods. Periods usually become painful within the first few years after you begin menstruating, and they become less common with age. Dysmenorrhea is split into two major categories.
- Primary dysmenorrhea occurs when there is pain with menses, typically crampy and located in the lower abdomen or lower back, without the presence of any diseases that could possibly be causing the pain. The pain typically begins as soon as menstrual bleeding occurs, or right before the start of bleeding and lasts one to three days.
- Secondary dysmenorrhea is when you have the same symptoms listed above, but along with a diagnosis like endometriosis which could be causing the pain. Secondary dysmenorrhea is more common in older women.
During menstruation, the lining of the uterus produces hormones called prostaglandins, which cause the muscle cells that make up the uterus to contract. The contractions lead to painful cramps that characterizes dysmenorrhea. These prostaglandins are also responsible for nausea and diarrhea during menses.
How is dysmenorrhea diagnosed?
Dysmenorrhea is usually diagnosed by your doctor with a history and physical examination. Additional testing, such as an ultrasound of the pelvis, may be performed to look for conditions like endometriosis or fibroids which could be causing the pain. Laboratory testing or imaging is usually not required.
How is dysmenorrhea treated?
First, let’s talk about non-pharmacologic treatments ― treatments that do not require medication. Herbal treatments, dietary and vitamin supplements have been studied on a small scale, but we do not have enough information about safety or effectiveness. Therefore, we don’t recommend any supplements for the treatment of dysmenorrhea. There have also been studies showing that yoga or acupuncture may help with dysmenorrhea and while this association needs to be further studied, these activities are not harmful and may be effective.
Studies have shown that exercise can lead to a decrease in menstrual pain. Since exercise also has many other benefits (decreased anxiety, depression, stress, diabetes, cancer, cardiovascular disease, in addition to improved cognitive functioning and more), we recommend regular exercise for those with dysmenorrhea. A heating pad, hot water bottle or a heating patch can also help decrease menstrual pain and can be used as often as necessary. Ensure that the temperature of the heating method you use is not higher than 104 degrees Fahrenheit to avoid burns.
There are a variety of medical treatments available for heavy periods or dysmenorrhea. Over-the-counter medications such as ibuprofen (Advil or Motrin) are the most commonly-used medication to treat dysmenorrhea. These medications provide pain relief in patients with heavy periods or dysmenorrhea by decreasing production of prostaglandins, the hormone which causes the cramps in the abdominal or lower back pain These non-steroidal anti-inflammatory drugs (NSAIDs) work best when taken right before or as soon as bleeding begins, and then taken regularly for two to three days. Talk to your doctor to be sure it is safe for you to use this readily available medication.
Hormonal birth control ― including the pill, patch, vaginal ring, injection, implant, IUD ― have been shown to be effective in controlling menstrual pain. These treatments thin the lining of the uterus, which means less of the prostaglandin hormone is produced, leading to less contraction of the muscle cells of the uterus that causes cramps. Patients taking hormonal birth control in the form of the pill, patch or ring normally take them in a way that allows them to have monthly periods.
Patients with severe dysmenorrhea can choose to take these treatments continuously and NOT have monthly bleeding; talk to your doctor to see how to use birth control for this added benefit. These treatments are usually effective for most people. If these treatments fail, then a detailed discussion with your doctor is necessary to determine what further testing or alternative medications may be necessary.
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