Dysmenorrhea: Symptoms, Causes & Treatment

Period pain, or dysmenorrhea, is pain and cramps in the lower abdomen that occur before or during menstruation, and is among the most common gynecological complaints, as a large proportion of women of reproductive age experience it to varying degrees. It is divided into two types: primary and secondary, each with a different cause and management.

Primary dysmenorrhea is the most common type and occurs without an underlying disease in the reproductive organs. Its cause is the secretion of a natural substance called prostaglandin that makes the uterine muscle contract strongly to expel its lining, producing the painful cramps. It usually begins with the start of the period, a day or two before, and lasts one to three days, with pain centered in the lower abdomen that may extend to the back and thighs, sometimes accompanied by nausea, headache, and fatigue. Secondary dysmenorrhea, however, results from an underlying organic cause such as endometriosis, adenomyosis, fibroids, or pelvic infection, often begins at an older age or worsens over time, and may persist outside the days of the period.

In mild to moderate cases of the primary type, simple measures help a lot: warm compresses on the abdomen, anti-inflammatory painkillers at the onset of pain, light exercise, and adequate rest. Hormonal birth control pills may help relieve pain in some women by the doctor's decision. But if the pain is severe and disrupts daily life, or has begun to worsen, or appeared at a late age, or is accompanied by heavy bleeding, pain outside the period, or pain during intercourse, these are indicators of a possible underlying cause (secondary dysmenorrhea) requiring gynecological evaluation. Severe pain is not something that must be endured; it can be controlled and its cause treated.

• Cramps and pain in the lower abdomen before or during the period.
• Pain extending to the back and thighs.
• Nausea, headache, and fatigue sometimes.
• In the secondary type: more severe pain or pain outside the period or heavy bleeding.

• Primary: prostaglandin secretion making the uterus contract strongly (without underlying disease).
• Secondary: endometriosis, adenomyosis, fibroids, pelvic infection.

• Medical history, pain pattern, and its relation to the period (the basis for distinguishing primary from secondary).
• Gynecological examination and ultrasound when an underlying cause is suspected.
• Additional tests (such as laparoscopy) in selected cases to diagnose endometriosis.

Primary type

• Warm compresses on the abdomen and adequate rest.
• Anti-inflammatory painkillers at the onset of pain.
• Regular light exercise, and sometimes hormonal pills by the doctor's decision.

Secondary type

• Treating the underlying cause (endometriosis, adenomyosis, fibroids...) under a gynecologist's supervision.

This content is educational and does not replace consulting a gynecologist; severe pain is not something to be endured.

• Impact on daily life, work, and study with severe pain.
• In the secondary type: complications of the underlying cause (such as effect on fertility in endometriosis).
• Delayed diagnosis of an underlying cause when worsening pain is neglected.

• Regular exercise and a healthy lifestyle may reduce pain severity.
• Taking the anti-inflammatory painkiller at the onset of pain (more effective than delaying it).
• Not neglecting worsening or unusual pain and seeing a gynecologist.