Menstrual periods can be painful without an obvious cause. This is labeled “primary dysmenorrhea”or “functional dysmenorrhea”. In other cases a cause can be found and this is called “secondary dysmenorrhea” or “acquired dysmenorrhea”. Some of the causes for acquired dysmenorrhea are: a narrow cervical canal, which requires more force of the uterus to empty itself with a menstrual period, which causes a lot of unnecessary pelvic pain.
The smooth muscle cells of the uterus are equipped to work against resistance as with a successful pregnancy the baby has to be expelled against resistance. With a small cervical canal it is like the woman has to go through labor pains with every period. The specialist (gynecologist) can help here by dilating cervix with a surgical procedure under an anesthetic. This is commonly known as a D&C (“dilatation and curettage”), which often can be done as an outpatient with a daycare procedure.
Other conditions can also lead to such painful periods, for instance uterus polyps or cervix polyps.
Other women have painful periods with a retroverted uterus (thanks to www.womens-health.co.uk for this link) and in these cases painful periods tend to run in the family. However, the doctor can often work out a drug regimen with anti-inflammatory drugs where this is taken just for a few days before the periods would have been painful in the past.
With primary dysmenorrhea despite a thorough work-up by the specialist no cause can be found. It is thought that prostaglandins are likely to blame, which originate from the endometrial lining of the uterus and lead to uterine contractions.
With dysmenorrhea there is pain in the lower abdomen, which is crampy, sometimes even colicky. The latter acute presentation is often associated with the passage of membranes and blood clots (called”membranous dysmenorrhea”). There are often generalized symptoms such as nausea, sometimes vomiting and headaches. The abdominal pain may also radiate into the lower back or into both legs. The woman with dysmenorrhea may also urinate more often and complain of constipation or diarrhea.
The physician needs to examine the patient and if everything checks out O.K., reassure the patient that everything is normal.
Treatment for Dysmenorrhea
The doctor likely will recommend that a woman with dysmenorrhea take a prostaglandin synthetase inhibitor 1 or 2 days before the menstrual period begins and to continue this until 1 or 2 days after it finished.
Popular prostaglandin inhibitors are: ibuprofen (brand names: Motrin, Advil, Ibu, Rufen), naproxen (brand name: Anaprox, Synflex), mefenamic acid (brand names: Ponstan, Ponstel). Essentially these medications help to reduce the prostaglandin, which is released around the time of the menstruation thus relieving the cramps and pain in the uterus. However, it only works optimally when the woman takes it early enough as otherwise the prostaglandins already released into the system will continue to produce symptoms.
If this medication does not work, the doctor likely will suggest an oral contraceptive, not for the purposes of avoiding pregnancy, but because it has been shown in the past that women with dysmenorrhea got surprising relief with the birth control pill. The standard low-dose estrogen-progesterone contraceptive pills will suppress ovarian function and this way help to normalize the periods and avoid the prostaglandin induced pain cycle. Your doctor will advise you which BCP to take, but some of the more common ones are listed here: Cyclen, Tri-Cyclen, Lo/Ovral, Desogen, Ortho7/7/7, Ovcon, Tri-Norinyl, Genora, Min-Ovral, Nordette and many others.
If this does not help, it is advisable to ask for a referral to a gynecologist in order to have more testing done.
Endometriosis is a common cause for painful periods. Often the specialist may recommend a surgical removal of the endometriosis lesions through an endoscopic procedure or else the prolonged taking of the birth control pill or Provera (a progestin, which is different from bio-identical progesterone, Ref.11). However, these artificial hormones do not fit the hormone receptors in the body causing potentially serious side-effects and functioning as unopposed estrogen stimuli that make endometriosis worse. The surgical procedure may help for a few periods, but then they re-grow and the patient may be worse off later. The solution to this dilemma is described in the next paragraph (the use of bio-identical progesterone cream).
Hormonal Dysbalance and Endometriosis
Dr. John Lee (Ref.10 and11) has written extensively about the connection of endometriosis to both estrogen dominance and lack of progesterone. Xenoestrogens, which are estrogenic substances in the environment (diethylstilbestrol, polychlorinated biphenyl or PCB, Bisphenol A etc.), but also petrochemical xenohormones such as pesticides can block estrogen receptors leading to a lack of ovulation and subsequent lack of progesterone. The body produces more androgens (male hormone products) that get transformed into estrogen in fatty tissues such as the breasts. These excess estrogens over stimulate the lining of the uterus, which in turn is responsible for the development of endometriosis.
For a woman with endometriosis bioidentical progesterone cream is given with daily doses of 40mg to 50mg per day from day 10 to 26 of the cycle. With this treatment protocol it can take up to 6 months for symptoms of endometriosis to subside. Some women continue to have some residual symptoms. This treatment protocol must be continued until menopause to prevent recurrences and complications. It must be stressed here that only the natural, bioidentical progesterone (available through a compounding pharmacy) will be effective, not one of the synthetic progestins (Ref. 11).
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6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.
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8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
9. Suzanne Somers: “Breakthrough” Eight Steps to Wellness– Life-altering Secrets from Today’s Cutting-edge Doctors”, Crown Publishers, 2008
10. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. Page 360 to 374 explains xenohormones. Page 184 and pages 251 and 252 describe the dosing of progesterone in endometriosis.
11. Dr. John R. Lee: Natural Progesterone- The remarkable roles of a remarkable hormone”, Jon Carpenter Publishing, 2nd edition, 1999, Bristol, England.