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Painful rules (dysmenorrhea) symptoms causes and treatment

The term dysmenorrhea refers to menstrual disorders in general (Greek due = difficulty) but it is commonly used to refer to pain in the lower abdomen that precede or accompany menstruation. They usually last from 2 to 3 days. The term algomenorrhea is more exact, the prefix algos meaning “pain”.

The menstrual pain affects 50% to 80% of fertile women, by age group. Of these, between 5% and 15% of women are sufficiently inconvenienced to have to modify their daily activities (forced rest, absenteeism from school or work).

The menses are often painful to the late teens and in the years before menopause because they are periods of hormonal fluctuations. The pains that occur at these moments of life are generally not worrying and hide no underlying gynecological disorder. In teenage girls, the pain decreases with the years and often disappears after a first pregnancy. When they are very intense and persist after bleeding, these pains can be suggestive of endometriosis.

When to consult?

  • When menstruation is accompanied by disabling pain that affects the quality of life and morale;
  • When women menstruate for several years, menstrual cramps intensify or are accompanied by menorrhagia (overabundant menstruation) or unusual intermenstrual bleeding.
Seek medical attention promptly if menstrual pain accompanies or has been preceded by fever or abnormal vaginal secretions.

Possible complications

In the vast majority of cases, dysmenorrhea has no other consequence than the inconveniences related to pain. When it is especially intense, repeated and not relieved, it can lead to psychological distress and sometimes even depression.

However, it is important to treat a gynecological disorder that causes dysmenorrhea to prevent it from getting worse.

How are the pains of the rules explained?

The pains felt in the lower abdomen or lower back are related to the contractions of the uterus. In the absence of pregnancy, the egg has not been fertilized; the ovaries suddenly stop producing estrogen and progesterone. This triggers uterine contractions, whereby the endometrium (lining of the uterus) and blood are expelled. In some women, the uterus contracts more intensely. This is the main cause of menstrual pain. This phenomenon is explained by an overproduction of prostaglandins, substances secreted inter alia by the endometrium and which trigger the contractions. (Prostaglandins also act on muscles other than the uterus, which explains the discomfort that can accompany dysmenorrhea: nausea, vomiting, headache.)

Moreover, the perception of contractions is very variable from one woman to another. Some will feel their stomach a little more sensitive, others will be very painful. Usually, the pains are more important at times when the menses are abundant because the uterus has to contract more intensely to evacuate the endometrium.

Symptoms of Painful rules (dysmenorrhea)

The symptoms of dysmenorrhea last from 2 to 3 days, on average.

  • The deaf or spasmodic pain (with throbbing) in the lower abdomen, which begin just before menstruation and persist for several days;
  • Sometimes the pain radiates to the lower back and inside the thighs;
  • A feeling of general malaise and weakness ;
  • Headaches;
  • Diarrhea;
  • Nausea and vomiting.

People at risk for Painful rules (dysmenorrhea)

All women can suffer, but the following factors increase the risk:

  • have a mother or sister who is suffering from or has suffered from  dysmenorrhea ;
  • have been puberty before the age of 11;
  • have excess weight
  •  Live in difficult social or psychological conditions.

Risk factors for Painful rules (dysmenorrhea)

Some lifestyle habits seem to contribute to menstrual pain:

  • smoking;
  • Lack of physical exercise;
  • Drink alcohol during menstruation;
  • Being anxious, stressed or in psychological distress;
  • Wear an intrauterine device (IUD) to copper.
    In contrast, the Mirena, a progestogen-containing device, can significantly reduce menstrual pain (see Medical Treatments ).

Prevention of painful menstruation (dysmenorrhea)

Basic preventive measures

Dietary recommendations for both preventing and relieving menstrual pains

  • Reduce your consumption of refined sugars. Sugars lead to overproduction of insulin and excess insulin causes the production of pro-inflammatory prostaglandins ;
  • Consume more fatty fish (mackerel, salmon, herring, and sardines), flaxseed oil and seeds, and hemp seed oil and seeds, which are important sources of omega-3. According to a small epidemiological study carried out in Denmark among 181 women aged 20 to 45, the women with the least dysmenorrhea were those who consumed the most omega-3 fatty acids of marine origin ;
  • Eat less margarine and vegetable fats, which are sources of trans fat that cause pro-inflammatory prostaglandins;
  • Eliminate red meats, which have a high content of arachidonic acid (a fatty acid at the source of pro-inflammatory prostaglandins). A study conducted in 2000 with 33 women suggests that a vegetarian diet low in fat is effective in reducing the intensity and duration of dysmenorrhea.
  • Check with the help of a nutritionist the presence of a deficiency of vitamin C, vitamin B6 or magnesium. These micronutrients would be essential for the metabolism of prostaglandins and their deficiency would cause inflammation.
  • Avoid drinking coffee when pain is present. Instead of releasing fatigue and stress, coffee will increase the pain because its effects on the body are similar to those of stress.

See also the advice of nutritionist Hélène Baribeau: Special diet: Premenstrual syndrome . Some relate to the relief of menstrual pain.

Stress management

The chronic stress would be equally harmful to the body that an unbalanced diet. Indeed, the stress hormones (adrenaline and cortisol) cause the production of pro-inflammatory prostaglandins. The Mayo Clinic suggests to women who experience painful menstruation every month to incorporate practices such as massage, yoga or meditation into their lifestyle 7. You also need to understand where the stress comes from and find strategies to better manage it. See also our file Stress and anxiety.

 

Omega-3, prostaglandins and painkiller effect

Some experts, including the, say that a diet rich in omega-3 helps reduce menstrual pain due to their anti-inflammatory. More specifically, the anti-inflammatory effect comes from substances produced by the tissues from omega-3 ingested, for example from certain prostaglandins (see explanatory diagram at the beginning of the Omega-3 and omega-6 form). This type of diet would also reduce uterine contractions and therefore the pain they can cause.

Prostaglandins have very varied and powerful effects. There are twenty types. Some, for example, stimulate uterine contractions (see box above “How do menstrual pain explain?”). Those with anti-inflammatory activity are mainly derived from omega-3s (fish oils, seeds and linseed oil, nuts, etc.). Prostaglandins, which in excess can have a pro-inflammatory effect, are rather derived from omega-6 contained in animal fat.

This is entirely consistent with the proposal of other experts to return to a diet that provides an adequate ratio of omega-6 and omega-3 to reduce the incidence of inflammatory diseases and improve cardiovascular health. Indeed, it is generally estimated that the ratio omega-6 / omega-3 in the western diet is between 10 and 30 to 1, while it should ideally be between 1 and 4 to.

Medical treatments of Painful rules (dysmenorrhea)

Pharmaceuticals

Nonsteroidal anti-inflammatory drugs. Menstrual pain is usually relieved by the use of nonsteroidal anti-inflammatory drugs (NSAIDs), the effect of which is to hinder the formation of pro-inflammatory prostaglandins. Ibuprofen (Advil, Motrin) is available over-the-counter. Another type of NSAID may be prescribed by the doctor if ibuprofen is not suitable, such as naproxen (Anaprox, Naprosyn) or mefenamic acid (Apo-mefenamic, Ponstan). They are used as soon as the symptoms appear, for 2 or 3 days. They relieve pain caused by uterine contractions as well as headaches, nausea and diarrhea. Nonsteroidal anti-inflammatory drugs can cause side effects, the most common of which are heartburn, diarrhea, abdominal pain and headaches.

Although NSAIDs are generally effective, 20% to 25% of women are not relieved by these drugs.

Oral contraceptives. Symptoms can also be alleviated by taking an oral contraceptive, which prevents ovulation, reduces prostaglandin production and reduces menstrual flow. This method is generally effective in reducing not only the duration and abundance of menstruation but also the pain that accompanies it. Some people also choose to stop menstruating by taking the birth control pill continuously, which solves the pain problem indirectly or by switching to Depo-Provera(an injectable contraceptive that causes amenorrhea).

It is also possible to take contraception containing a progestin alone, continuously. In general, menstrual periods are much less abundant and sometimes stop during treatment, which solves the problem of pain. The menstruation resumes at the end of the treatment.

Contraceptive by injection. Depo-Provera(a contraceptive administered by injection that causes amenorrhea) is also available but it is not devoid of adverse effects: irregular bleeding, weight gain, decreased libido. In addition, these effects cannot be stopped once the substance is administered and one must wait until the end of the efficacy (4 months) to return to normal.

Intrauterine device (IUD). Another option is to wear the Mirena IUD. It is an intrauterine device containing a progestin. It fits into the uterus. In addition to being contraceptive, it significantly reduces menstruation and pain. It only needs to be changed every 5 years.

In case of dysmenorrhea caused by a gynecological disorder, the doctor will treat the condition causing the pain. See our Uterine Fibroma and Endometriosis fact sheets for more information about their treatment.

Tips to reduce pain:

  • Place a heating pad or hot water bottle on the abdomen or lower back;
  • Take a hot bath or shower;
  • Do light exercise, for example, stretching, walking or cycling;
  • Rest and avoid stressful situations when menstruation is approaching.

Complementary approaches

Caution.  The clinical studies reported in this section focus on dysmenorrhea that occurs in adolescence or just before menopause, when pain is not caused by a particular gynecological problem (such as endometriosis). In case of sudden and severe menstrual pain, consult a doctor.

 

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