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Dysmenorrhea (Painful Periods)

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Dysmenorrhea, or painful periods, is the most commonly reported menstrual issue and affects more than 50% of women. I think most of us have experienced pain associated with our cycles and have even come to expect it once a month. It’s just something we deal with as women. As a Midwife, I’ve seen women who stated they never felt discomfort with their periods to those who had debilitating pain that caused them to miss work/school. All of our bodies are different and our response to pain is also different. However, did you know that there are two types of dysmenorrhea? They are called primary and secondary dysmenorrhea. Today, I’m going to explain the difference between the two, as well as the causes and treatments.

Primary Dysmenorrhea

Primary dysmenorrhea is categorized by common menstrual cramps that occur with every period. Women who experience this have noticed this recurrent pain since they started menstruating, and it’s caused by prostaglandins (natural chemicals in our body) that make our uterus contract. A few days before you have your period, you may notice the cramping as prostaglandin increases in the lining of your uterus. The more prostaglandin, the more cramping. However, as your period continues, you shed your uterine lining, which causes prostaglandin levels to decrease and lead to less pain. Primary dysmenorrhea causes pain in the lower abdomen, back, and/or thighs, and can be associated with nausea, vomiting, diarrhea, and fatigue. The good news is that this type of dysmenorrhea often improves with age and after giving birth.

Secondary Dysmenorrhea

With secondary dysmenorrhea, the pain often occurs later in life and is caused by a reproductive disorder. Also, the pain usually becomes worse, as opposed to better, as the period continues and may even linger beyond the duration of the period. Certain disorders that could cause secondary dysmenorrhea are:

  • Endometriosis - tissue from the lining of the uterus (the endometrium) is found outside the uterus, such as the ovaries, tubes, on the bladder, etc.

  • Adenomyosis - tissue that normally lines the uterus grows in the muscle wall of the uterus

  • Fibroids - growths on, inside, or in the walls of the uterus

  • Pelvic inflammatory disease - bacterial infection in the uterus and other reproductive organs

Secondary dysmenorrhea is obviously more concerning and requires evaluation by your provider. If you notice that your periods are more painful than they used to be and/or that the pain lasts longer, please make an appointment. More than likely, a pelvic ultrasound will be done. They may also consider doing a laparoscopy, which is an exploratory surgery of the pelvic region.


Depending on the type of dysmenorrhea you have, as well as the cause, you may need one or a mixture of treatments. It’s always best to consult with your provider to ensure you are treating any underlying issues.

  • Pain relievers - You may find ibuprofen helpful if you do not have an allergy to it. You can also consider Tylenol and aspirin. It’s best to start taking the pain medicine at the first sign of your period or pain for it to be effective

  • Birth control - your provider may prescribe birth control if it’s safe for you to control your pain. This may also make your periods lighter and less days. Check out my birth control blog post here.

  • Lifestyle changes - It’s best to avoid caffeine, smoking, and alcohol. Exercising regularly can also help you have less menstrual pain.

  • Comfort measures - A warm bath, heating pad, or massage of the lower back and abdomen can help to relieve pain.

  • Surgery - If fibroids are the culprit and greatly affecting your daily life, your provider may recommend removing them. However, please note that just because you remove fibroids, that doesn’t mean they won’t come back. If you have endometriosis, tissue can be removed during surgery as well. This may return too, but it can help to relieve severe pain for a period of time. Hysterectomy, or removal of the uterus, is extreme but may be considered as a last resort if you have no interest in having more children.

I hope you learned something new today about the difference between primary and secondary dysmenorrhea. Can you identify with any of these symptoms?

xoxo, Global Midwife

Disclaimer: This is not medical advice, only education. Always check with your healthcare provider. I may make a small commission on some of the items linked on this page through affiliate links/codes.



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