Sponsored: Painful menstruation

Affecting as many as 9 out of 10 adolescent girls^1a,b Painful menstruation can have a profound impact on the lives of woman who struggle with it and is responsible for significant absenteeism from work.

It is also the most common reason for school absenteeism among adolescent girls.^1c

What does menstrual pain feel like?

• The pain is usually crampy or sharp and comes and goes, but it may be a dull, constant ache. It sometimes extends to the lower back and legs.^2a

• The pain tends to be most intense about 24 hours after periods begin and to subside after 2 to 3 days.^2a

• Many women also have a headache, nausea (sometimes with vomiting), and constipation or diarrhoea. They may need to urinate frequently.^2a

Symptoms tend to be more severe if:^2b

• Menstrual periods started at an early age.

• Periods are long or heavy.

• Women smoke.

• Family members also have dysmenorrhoea.
  

What causes menstrual pain?

Menstrual cramps may have no identifiable cause (called primary dysmenorrhoea), or result from another disorder e.g. endometriosis (called secondary dysmenorrhoea)^2c Primary dysmenorrhoea usually starts during adolescence and may become less severe with age and after pregnancy. It is more common than secondary dysmenorrhoea, which usually starts in adulthood.^2c

Experts think that primary dysmenorrhoea may be caused by release of substances called prostaglandins during menstruation. Prostaglandin levels are high in women with primary dysmenorrhoea. Prostaglandins may cause the uterus (womb) to contract, as occurs during labour, reducing blood flow to the uterus.

These contractions can cause pain and discomfort. Prostaglandins also make nerve endings in the uterus more sensitive to pain. Lack of exercise and anxiety about menstrual periods may also contribute to the pain.^2d

The good news! Menstrual pain can be treated!

Treatment of painful menstruation aims to relieve the symptoms and address any underlying processes which may cause these symptoms^1e. Pain killers, direct application of heat and nonsteroidal anti-inflammatory agents (NSAIDs) are common effective strategies to manage menstrual pain.^1h 

Nonsteroidal anti-inflammatory agent such as ibuprofen can be used to treat menstrual pain with great success.^1d,e Ibuprofen also has additional anti-inflammatory properties, and inhibits the prostaglandins implicated in menstrual cramps.3^,1f 

Agents with a faster onset of action such as ibuprofen are often preferred.^1g If NSAIDs are ineffective, doctors may recommend also taking birth control pills that contain a progestin and a low dose of oestrogen with the NSAID.^2e Birth control pills which block monthly ovulation and may decrease menstrual flow, may also relieve symptoms.¹ⁱ

<sup>References:
1. Calis KA. Dysmenorrhoea. Medscape [online] September 2019 [cited] 8 June 2020; Available from URL: https://emedicine.medscape.com/article/253812-overview#a6
2. Pinkerton JV. Menstrual Cramps. In: Merck Manual Consumer Version [online] July 2019 [cited 8 June 2020]; Available from URL: https://www.merckmanuals.com/home/women-s-health-issues/menstrual-disorders-and-abnormal-vaginal-bleeding/menstrual-cramps?query=period%20pain#
3. Product package insert, October 2015.</sup>

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