Primary and secondary dysmenorrhea: How to make periods stop hurting

Women's Health
Woman having stomach pain lying on sofa

Dysmenorrhea is the medical term for menstrual pain and discomfort. Women can experience dysmenorrhea before, during, or after their menstrual cycle.

There are two types of dysmenorrhea — primary and secondary dysmenorrhea. Primary dysmenorrhea involves pain that is cyclical and caused by menstruation itself.

Secondary dysmenorrhea involves non-cyclical (unrelated to menstruation) pain that may be triggered by an underlying condition such as endometriosis, pelvic inflammatory disease, or fibroids.

"Menstrual pain is common, but it's not normal," says Dr. Joseph Gobern, a Main Line Health obstetrician-gynecologist who specializes in minimally invasive and robotic-assisted gynecologic surgery. If pelvic pain is disrupting your life, talk to a doctor. There are plenty of non-invasive interventions that can help alleviate symptoms of dysmenorrhea and make your menstrual cycles less painful.

How severe is dysmenorrhea?

"If you are having pain that precedes your menstrual cycle, then it's likely from a secondary cause of disease that is then stimulated by the hormonal cycle rather than what is happening primarily in your uterus and menstrual bleeding," explains Gobern.

Severity and symptoms of dysmenorrhea vary between women, but commonly include pelvic pain, abdominal cramping, lower back pain, pain radiating down the legs, nausea and fatigue. These symptoms can be significantly distressing or disruptive to people's lives. The severity and timing of symptoms largely depends on what is causing the pain. In people under the age of 45, it's very rare for dysmenorrhea to be related to cancer or a related malignancy, according to Gobern.

How is dysmenorrhea diagnosed?

Visit your health care provider, and they will first take a look at your medical history. They'll also ask you various questions to understand how the pain is impacting your quality of life, relationships, and the goals you want to achieve, such as becoming pregnant.

They'll also want to know what triggers the pain — e.g., sexual activity and exercise — and if the pain is cyclical or non-cyclical. It can be helpful to keep a journal to help your medical team pinpoint when the pain flares up.

This information, along with the results from your annual Pap smear, can help your provider determine the source of the pain and inform the type of tests that may be necessary to get a diagnosis. Each person's fertility desires and family-planning goals will also help inform the testing timeline.

Imaging tests, like a pelvic ultrasound, can help identify non-cyclical pain. These tests can help identify any abnormal anatomical issues. In certain cases, a non-invasive surgical procedure may be necessary to get a diagnosis.

Some cyclical pain, for example, may be caused by endometriosis. A laparoscopy, or a diagnostic surgical imaging procedure, can help identify endometriosis. If the pain is non-cyclical, other specialists may need to weigh in to determine if there is a medical issue with the bladder, bowel, or other organs.

What to do if you have dysmenorrhea? How is it treated?

Common menstrual pain, or primary dysmenorrhea, is usually manageable with over-the-counter non-steroidal medications, such as acetaminophen or ibuprofen. Gobern says using acetaminophen and ibuprofen together can help reduce the inflammation and pain caused by dysmenorrhea.

Exercise, rest, a heating pad, and avoiding caffeine and smoking can also help relieve menstrual pain.

A hormonal contraceptive is the first line of treatment for those not actively pursuing pregnancy. According to Gobern, there are very few side effects or long-term harm, and in fact many benefits, to using hormonal contraception. "If that controls the symptoms, you really don't have to go any further," says Gobern. If the pain persists, there are other medical and surgical options that can be explored.

If symptoms are impacting your quality of life, it's time to talk to a doctor.

For more information on dysmenorrhea, or to schedule an appointment with a women's health specialist, please call 1.866.CALL.MLH (225.5654).