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It’s That Time of the Month! Let’s Talk About Period Pain

Edited by Mirabella Chan


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Dysmenorrhea


Having a period is already an unenjoyable time of the month. From the bleeding to the bloating to the mood swings, it can be dreaded period of time for many. Adding period pain into the mix can make everything feel so much worse. Dysmenorrhea is a Greek term meaning “painful monthly bleeding” and describes cyclic pain with symptoms including lower abdominal pain, cramps, nausea, and vomiting. In a study of those who experienced periods between the ages of 16-25, 88% of the participants reported suffering from dysmenorrhea. With dysmenorrhea affecting this many people, it is no wonder that it is one of the leading causes of missed school and work.



Types of Dysmenorrhea


There are two main types of dysmenorrhea: primary and secondary. Primary dysmenorrhea is akin to period pain and describes the feelings of repeated crampy, lower abdominal pain that occurs during menstruation. This type of dysmenorrhea can typically be self-managed with over the counter medications. Conversely, secondary dysmenorrhea consists of the same painful symptoms but is not due to menstruation. Health conditions such as endometriosis, adenomyosis, or uterine fibroids could all cause this type of pain and require more specialized treatment. If you think you are experiencing dysmenorrhea, it is important to be evaluated by a healthcare professional to determine which type it is so that it can be treated most appropriately.



Who is at Risk of Dysmenorrhea?


Many risk factors exist for dysmenorrhea, some of which can be controlled while others are inherent. These risk factors include:

  • Age younger than 25

  • Smoking

  • First period occurring before the age of 13

  • Never having given birth ("nulliparity")

  • Longer and heavier menstrual flow

  • Family history of dysmenorrhea

  • Anxiety and depression


Common Symptoms


While some of the main symptoms of dysmenorrhea have already been listed, those who experience periods may experience a wide range of symptoms. Some of these symptoms include:

  • Lower abdominal and/or back pain

  • Cramping

  • Pain radiating down the legs

  • Nausea, vomiting, diarrhea

  • Fatigue

  • Weakness

  • Headaches

Signs that should alert you to see a doctor to investigate other possible causes include:

  • New vaginal discharge

  • Fever or chills

  • Fainting

  • Abdominal pain accompanied by painful urination or bladder discomfort

  • Pain that persists throughout the menstrual cycle


Treatment Options


The most important thing for those suffering from primary dysmenorrhea is how to treat it. There are two main treatment options that can be chosen from. These options include anti-inflammatory drugs and hormonal contraceptives.


Anti-inflammatory medications can be used to treat primary dysmenorrhea. This includes ibuprofen (Advil) and naproxen (Aleve). These drugs work by inhibiting the production of prostaglandins which are involved in causing the painful uterine contractions. Acetaminophen (Tylenol) can also be used to treat primary dysmenorrhea but it has been found to be less effective compared to anti-inflammatories. If over-the-counter doses are not effective, prescription doses may be used under the guidance of a health professional, which is integral for safety. Did you know that after January 1st, 2023, pharmacists in Ontario will be able to prescribe prescription doses of anti-inflammatories for patients?


Estrogen and progestin are two hormones found in the body and are also used in contraceptive medications. For those who wish to use a hormonal contraceptive or who have no objections to the use of hormonal contraceptives, estrogen-progestin methods (available in the form of a pill, vaginal ring, or transdermal patch) or progestin-only intrauterine devices (Mirena, Kyleena) are considered first-line options. These hormonal methods work by suppressing ovulation, which ultimately leads to smaller amounts of prostaglandins. The choice of a specific hormonal contraceptive is ultimately determined based on medical history and personal preferences. Hormonal contraceptives are only available by prescription from a licensed prescriber.


Aside from the above drug options, both exercise and heat therapy such as hot water bottles have shown to be effective additional therapies to reduce symptoms of primary dysmenorrhea.



Conclusion


Many people around the word experience period pain and healthcare professionals are here to help! From anti-inflammatory medications to hormonal contraceptives, there are many ways that your local trusted healthcare professional can help you manage your period pain. Just remember, when that time of the month rolls around, there is no need to suffer through your period pain.



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References

  1. Subasinghe AK, Happo L, Jayasinghe YL, Garland SM, Wark JD. Prevalence and severity of dysmenorrhoea, and management options reported by young Australian women. Australian family physician. 2016;45(11):829-834. doi:10.3316/informit.429395266870816

  2. Vlachou E, Owens DA, Lavdaniti M, et al. Prevalence, Wellbeing, and Symptoms of Dysmenorrhea among University Nursing Students in Greece. Diseases. 2019;7(1):5-. doi:10.3390/diseases7010005

  3. Smith R, Kaunitz A. Dysmenorrhea in adult females: treatment. UptoDate. UptoDate; 2022. Accessed September 23 2022. www. Uptodate.com

  4. Hong JU, Jones M, Mishra G. The Prevalence and Risk Factors of Dysmenorrhea. Epidemiologic reviews. 2014;36(1):104-113. doi:10.1093/epirev/mxt009

  5. Pakniat H, Jahanian S, Hemmati N, Ranjkesh F. The Association of Anthropometric Indices with Dysmenorrhea in High School Students: A Cross-Sectional Study. International journal of school health (Online). 2018;6(1):1-6. doi:10.5812/intjsh.80870

  6. Minor ailments. OCPInfo.com. https://www.ocpinfo.com/practice-education/expanded-scope-of-practice/minor-ailments/. Published July 12, 2022. Accessed September 24, 2022.

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