Painful Periods (Dysmenorrhea)

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Why do my periods hurt so much?

During your period, your uterus makes chemicals called “prostaglandins”.

Prostaglandins cause contractions of the uterus, which causes pain.

These contractions are similar to the ones that happen during childbirth and can be very painful.  They may begin 1-2 days before your period starts.

What symptoms might occur during this time of painful periods?

The main symptom is pain.

The pain may be crampy and usually is located in the lower part of the abdomen (stomach); some girls also have pain in the back or thighs.

You may also have other symptoms, such as:

• Nausea
• Diarrhea
• Extreme tiredness/fatigue
• Headache
• Bloating (a feeling of fullness in the abdomen)
• Dizziness
• Flu-like feelings

How is dysmenorrhea diagnosed?

Diagnosis is usually made based on your history and physical exam.  Unless you are sexually active or have unusual symptoms, an internal pelvic exam is not usually needed.

Is there anything I can do at home to feel better?

There are several things you can do at home to feel better.

#1 – Nonsteroidal Anti-Inflammatory Drugs

These medications include ibuprofen (Advil, Motrin) and naproxen (Aleve). They are prostaglandin inhibitors and will help to decrease the pain associated with your period.  Take them as soon as bleeding or other menstrual symptoms start and continue for 2-3 days; they are most helpful if you take them regularly.  Check with your healthcare provider to make sure you are taking the correct dose.

#2 – A Heating Pad or Hot Water Bottle

Place a heating pad or hot water bottle on your lower abdomen.

#3 – Exercise

Exercise on a regular basis (not just during your period, but all the time!).  Also, make sure you are eating a healthy diet and getting enough sleep (8-9 hours/night).

#4 – Complementary or Alternative Medicines

There is some evidence that yoga, acupuncture or meditation may be effective in reducing painful periods.

Is there anything else I can do?

Birth Control Pills

Birth control pills and other forms of hormonal birth control (eg. patch, injection, hormone-releasing intrauterine device, contraceptive implant) also are effective treatments.  These treatments work by thinning the lining of the uterus, where prostaglandins are made, decreasing the contractions that cause pain and cramping.

Intrauterine Device (IUD)

The IUD that contains the hormone levonorgestrel (Mirena, Skyla, Kyleena, Liletta) can reduce painful periods by as much as 50%.  In a study performed in teenage girls 12-17 years of age, use of a smaller, lower-dose levonorgestrel IUD (Kyleena) reduced dysmenorrhea.

When should I see a medical provider for menstrual cramps?

You should see a provider if:

• the pain is getting worse
• pain medicine is not helping
• you also have pain well before or well after your period
• you are sexually active (STDs can increase painful periods)
• you are experiencing irregular bleeding as well as pain
• you feel depressed, sad or hopeless with your painful periods

If you have any of these symptoms, call for an appointment at 919-235-6505.

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About Valerie Rinehammer, CPNP

Valerie is a certified pediatric nurse practitioner with WakeMed Pediatric Primary Care in Clayton, NC. Learn more about Valerie and schedule an appointment with her here.