Menstrual pain: what’s normal?

You’re going about your day when suddenly, you feel that dreaded twinge of pain in your lower abdomen. You check your calendar and it all makes sense. For the next couple days, you know that your heating pad is going to be your best friend. Have you ever wondered what causes menstrual pain and what pain is normal? Read on to find out!

What causes menstrual pain

During menstruation, chemicals called prostaglandins are released to cause uterine contractions, which help to shed the uterine lining. Prostaglandin levels rise leading up to menstruation and decrease once menstruation has started. Usually, this means that pain levels decrease. Unfortunately, for some, these contractions may be painful and accompanied by bothersome symptoms. Does this sound familiar?

Pain that is associated with menstruation is referred to as dysmenorrhea, a Greek term for “painful monthly bleeding.” Dysmenorrhea is one of the most common gynecological concerns among those who menstruate and a common cause of pelvic pain, affecting more than half of women who menstruate. Usually the pain is mild and lasts 1 to 2 days each month, but some women experience severe pain that may prevent them from being able to participate in their regular activities. It can be more common if you began menstruating before the age of 12, experience heavy or irregular periods or have a low body weight. The pain usually occurs within the pelvis or lower abdomen, but may radiate to the low back and inner thighs. As you can imagine, this can have significant impact on your life depending on the severity of the pain.

Understanding the two types of menstrual pain

There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea.

Primary dysmenorrhea consists of lower abdominal pain that occurs during the menstrual cycle and is not associated with any other medical conditions or underlying pathologies. Pain typically starts 1 to 2 days before the beginning of your period and subsides shortly after bleeding starts. This form of dysmenorrhea is the most common type and typically begins within the first couple years following menarche, a female’s first menstrual cycle, and thus is most diagnosed in adolescents and young adults. It can also be accompanied by symptoms such as nausea, vomiting, constipation, headaches, fatigue, difficulties with sleep and dizziness.

Secondary dysmenorrhea is associated with suspected or confirmed pathologies, such as endometriosis, uterine fibroids, adenomyosis, endometrial polyps, pelvic inflammatory disease and even large cesarian section scars. Pain may begin earlier in the menstrual cycle and lasts longer than pain associated with primary dysmenorrhea. This form of dysmenorrhea is less common and can begin to affect women at any time following menarche, even decades later, in their 20s, 30s, or even 40s. It may be associated with differing intensities of pain, as well as other symptoms such as dyspareunia (pain with sexual intercourse), intermenstrual bleeding (bleeding between menstrual periods), post-coital bleeding (bleeding following sexual intercourse) and menorrhagia (heavy menstrual bleeding).

Treatment options for managing painful periods

Fortunately, there are treatments available to help you manage symptoms and return to the activities you enjoy. Some patients may benefit from a combination of these treatment approaches to best address their symptoms. The most popular pharmacological treatment is the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen beginning 1 to 2 days before onset of menstrual pain, which may be effective in reducing pain intensity. Chat with your doctor to see if pharmacological options might be right for you.

Many nonpharmacological management options also exist, meaning that these approaches do not involve medications. These include: heat application to the lower abdomen or back, regular exercise and an active lifestyle, a balanced diet rich in vitamins and minerals to reduce the severity of dysmenorrhea and the use of transcutaneous electrical nerve stimulation for pain relief. Pelvic physiotherapy can also help to manage symptoms through deep breathing exercises, mindfulness strategies, muscle and tissue releases, and more.

Learn more about pelvic floor health and physiotherapy on our services page. For pain management, our Lifemark clinicians can help you manage your symptoms and help you get back to your regular activities. Find a location or book an appointment to get started.

This article was written by Emily Gunning, a physiotherapy student at the University of Toronto.