Painful periods since adolescence

Painful periods should be a call to action to improve the overall health status of the young woman suffering on a monthly basis

Primary Dysmenorrhea (painful periods) is characterized by cramping pain in the lower abdomen that may spread to the thighs and lower back. Usually lasting between 48 to 72 hours, the pain typically begins a few hours before or after menstruation onset. Other common symptoms include nausea, back pain, irritability, fatigue, breast tenderness, and absenteeism from school or work. Onset is typically between six months to two to three years after menarche (periods first starting). If symptoms begin more than three years after menarche, secondary dysmenorrhea should be considered.

Women with primary dysmenorrhea (PD) appear to have general enhanced pain sensitivity, which predisposes them to other chronic pain conditions, including fibromyalgia, bladder pain syndrome, irritable bowel syndrome, and migraine headaches. Along with the increased risk of anxiety and depression, it is important to seek out causes for secondary dysmenorrhea when symptoms begin more than three years after menarche.

Symptoms of Secondary Dysmenorrhea
Symptomatic pain of secondary dysmenorrhea often begins many hours or days prior to the onset of menstruation and can be more severe and last longer than the pain that is typically seen in primary dysmenorrhea.

What Causes PD?
While the full pathophysiology underlying primary dysmenorrhea is not fully understood, PD is characterized as an inflammatory condition associated with underlying oxidative stress. The process of menstruation is inflammatory by nature. In the absence of fertilization and implantation, the production of prostaglandins is necessary for the shedding of the womb lining (endometrium) which is induced by the drop in progesterone in the late part of the luteal phase of the menstrual cycle. The increased production of prostaglandins are responsible for the development of uterine contractions. Uterine contractions can be evoked by a variety of stimuli, including nutritional deficiencies, an inflammatory diet and lifestyle, as well as with elevations of adrenaline, certain peptide hormones, and steroid hormones, all of which can be stress-related.

How Can Sirona Health Help You?
There are several strategies to alleviate dysmenorrhea, including medication, hormone manipulation, dietary advice, supplements, exercise, botanicals, acupuncture, mind-body techniques, and bioenergetic approaches.

Medication

NSAIDs block prostaglandin production by inhibiting cyclooxygenase. They can be highly effective for menstrual pain. Taking 600-800 mg of ibuprofen or alternative more selective COX-2 NSAIDs starting 2-3 days prior to their anticipated onset of menses, then scheduled doses every 6-8 hours through the first several days of bleeding, can provide significant relief. However, nearly a quarter of women using NSAIDs do not experience adequate pain control of their period pain, and many experience significant side effects, including gastrointestinal effects, headache, drowsiness, dizziness, and dryness of the mouth. Ideally, NSAIDs should not be used as the sole treatment. They can be very helpful to alleviate symptoms while focusing on developing lifestyle habits that focus on minimizing inflammation.

Hormone manipulation is the other primary strategy for alleviating dysmenorrhea. The goal is to thin the womb (endometrial) lining and stop ovulation from occurring, thus reducing menstrual fluid volume, endometrial COX-2 levels and prostaglandin production. Treatment strategies include oral contraceptive pills with or without oestrogen, bioidentical progesterone during the luteal phase of the menstrual cycle, intravaginal contraception, levonorgestrel-containing intrauterine devices, and depot medroxyprogesterone acetate.

Dietary advice

Eating a diet high in fruits and vegetables, and avoiding missing meals during your period, can help alleviate symptoms.

Supplements

Omega-3 fatty acids, thiamine, vitamin B12, vitamin E, magnesium, zinc, and vitamin D have been shown to have some beneficial effects.

Exercise

Multiple studies support that aerobic exercise can be beneficial for dysmenorrhea and should be used as a first-line therapy. Exercise is moderately more effective than pain killers.

Botanicals

Valerian (Valeriana officinalis), ginger (zingiber officinalis), fenugreek (Trigonella foenum-graecum) and zataria (Zataria multiflora) are botanicals that have been shown to be effective for dysmenorrhea.

Acupuncture

The magnitude of clinical improvement with acupuncture is unclear, but the cost, risk, and side effect profile are generally low compared to other standard interventions.

Mind-body therapies

Yoga is a safe and effective treatment modality for both dysmenorrhea and pelvic pain.