The painful menstruation is underdiagnosed and undertreated, even though it is estimated between 50 and 90% of women have suffered pain rule at some point in their lives. Observing how this pain manifests itself, how it evolves, where it is located, and what other symptoms it is accompanied by is essential to determine if a pathological origin may be behind it. And if forced to miss school or work, although the third day disappears, it is appropriate consul tar to the gynecologist.
Period pain, whose technical name is dysmenorrhea, is a feeling of discomfort, discomfort, or discomfort of the cramping type or dull pain in the lower abdomen, especially in the first days of the rule.
Pathological dysmenorrhea refers to intense pain enough to interfere with our everyday life and therefore requires medical treatment, according to Raquel Rivas, a specialist in the Gynecology and Obstetrics service of the San Agustín Hospital, in Avilés (Asturias).
The causes of period pain can be organic or essential. In the first case, the origin of the pain is linked to pathology, such as endometriosis. In the second case, the pain is considered ‘normal,’ that is, it is not pathological, in the sense that the origin is “essential or idiopathic, as there is no disease behind it,” explains Raquel Rivas. The diagnosis of essential period pain is, therefore, one of exclusion.
Pain with menstruation is widespread, especially in adolescence, although knowing the percentage of women who suffer from it is very difficult, says this specialist. Thus, it is estimated that between 50 and 90% of women suffer period pain at some point in their life. It is striking that dysmenorrhea is an underdiagnosed and under-treated situation, despite being a problem suffered by many women.
Having a painful period is more common in the younger years, especially between 16 and 20. “From that age on, the number of women who suffer from it decreases a lot,” says Dr. Rivas, who states that “when it appears later, over 30 years of age, we have to suspect that there may be a disease behind it, for example, an endometriosis“.
Risk factors for dysmenorrhea are:
· Young age, particularly adolescents.
· There may also be a slight family predisposition to menstrual pain.
· It is also known that essential or primary period pain usually disappears or diminishes after the first delivery.
Why do we have pain with the period?
The cause of pain with menstruation, when it is essential or not pathological, is related to an alteration or increase in the contractibility of the uterus, whose wall is made up of muscle. Contractions of the uterus result in the expulsion during menstruation of the blood and the endometrium, which is the lining of the uterus from the inside. “Substances called prostaglandins are responsible for altering this contraction of the uterus when they increase in quantity,” explains this gynecologist, who adds that it is believed that they are also the cause of vomiting and diarrhea that sometimes accompany period pains.
By over-contracting the uterus muscle, it compresses or squeezes the blood vessels within it, and this lack of blood supply can also cause pain.
Differentiate ‘normal’ pain from pathological
Non-pathological period pain usually responds to the following characteristics:
1. It appears on the first day of menstruation or a few hours before.
2. It usually lasts a day or two and then goes away
3. It is discontinuous, colicky: it comes and goes, sometimes it is more intense and other times less
4. Its intensity is usually higher on the first day
5. It is usually located in the lower part of the belly and can go towards the lower part of the back of the thighs
6. And it is not uncommon for it to be accompanied by other manifestations such as:
“This period of pain, which is what we could consider” normal, “is the one that typically appears months after menarche (that is, the first period of our life), which is when ovulatory cycles begin. As the woman ages, the pain improves or disappears,” says Dr. Rivas.
Organic or secondary period pain is the one that should always be consulted because “it is the one that alerts us that a disease may cause it.”
It is a pain that:
· The whole period lasts, unlike the previous one
· It is usually a continuous pain, it does not come and go, and it remains constant.
· Usually more severe than essential menstrual pain
· Other symptoms in addition to pain accompany it
· Gets worse over time
· Improves with the treatment of the disease that causes it
Some of the diseases that can cause this pain with the rule are:
When to consult
It is important to note that when pain has an intense impact on a woman’s day-to-day life in the sense that, for example, it prevents her from going to work or class, or affects the development of daily tasks, even if only in the first days of period and then disappear, it is necessary to consult.
“The most frequent is that it is an essential period pain, that is, that the gynecologist does not find a pathology or disease, but may prescribe a treatment so that the woman stops suffering it,” says Raquel Rivas.
The characteristics of period pain that act as a warning signal and its origin should be investigated are:
· Pain that lasts throughout the period
· Localization on one side of the pelvis, instead of in the central area
· Gets worse over time
· If the pain is associated with sexual intercourse or defecation, it is also advisable to consult.
To diagnose the origin of a dysmenorrhoea, the specialist will perform a gynecological examination and a transvaginal ultrasound. “In general, it will not be necessary to carry out analytics or other complementary tests,” explains Dr. Rivas. The diagnosis of essential rule pain is made by exclusion, that is, “that both the examination and the ultrasound will be normal. If we suspect organic dysmenorrhea, then we may carry out other tests”.
Treatment will depend on the characteristics of the patient and the intensity of the pain. As general recommendations, it is advised:
1. Regular physical exercise
2. Balanced diet low in fat, maintaining an adequate weight
3. As a non-pharmacological treatment, local heat may be helpful.
The pharmacological treatment of essential dysmenorrhea is based on:
1. The non – steroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen. They work by decreasing the production of prostaglandins, which are the substances that cause pain and the other symptoms that accompany it. However, approximately 20% of patients with dysmenorrhea do not improve with this treatment.
2. The second pillar of treatment, which specialists can prescribe along with the first, is contraceptives.
Within the group of contraceptives are:
The combined oral pill
The vaginal ring
The transdermal patch
The progestogen-only pill or mini-pill
IUDs or intrauterine devices
Why do contraceptives work to treat period pain?
Contraceptives, in addition to suppressing ovulation, make the endometrium, the layer that covers the inside of the uterus and that flakes and bleeds with each rule, does not grow and is very thin. In this way, the production of prostaglandins is lower.
“The usual thing would be to re-evaluate its efficacy in consultation after 3 or 4 months of treatment,” says Raquel Rivas. She explains that some women may need a combination of several treatments.