Painful Periods: When Menstruation Hurts Too Much

Mild cramps and minor discomfort are a normal part of certain phases of the menstrual cycle. However, up to a third of women of reproductive age experience excruciatingly painful periods, accompanied by intense menstrual cramps that start days before menstruation and continue long after their periods end. These painful sensations aren’t just debilitating – they can also be life-limiting, interfering with daily life and affecting your ability to work or engage in social activities.

Painful periods – a condition known as dysmenorrhea – are not normal and can be a symptom of a more serious underlying condition. With an accurate diagnosis provided by the specialists at NextPain Care and an extensive care plan, you can identify and address the root causes of your condition without medications or surgery. Learn more below.

How Do Menstrual Periods Cause Pain?

The menstrual cycle is a complex process involving several glands, hormones, and organs. It consists of four main phases:

• Follicular: During the follicular phase, which starts on the first day of your cycle and lasts for up to 14 days, the body releases hormones that stimulate the production of follicles on the internal surface of an ovary. Only one of these follicles will then mature into an egg.
• Ovulation: During ovulation, a mature egg transfers from the ovary to the uterus via the Fallopian tube. Ovulation may last between 16 and 32 hours and represents the time when a woman is most fertile.
• Luteal: After ovulation, the interior lining of the uterus (endometrium) begins to grow, thicken, and swell in preparation for pregnancy. If you are pregnant, the endometrium will support the growth of the fetus and safeguard the egg from microbial invasions.
• Menstruation: If the egg is not fertilized and you are not pregnant, the body expels the unneeded endometrium through menstruation.

During the menstruation phase, the body produces high levels of a hormone called prostaglandin, which triggers the muscle contractions needed to expel the lining of the uterus. However, these contractions can cause pain, and high levels of prostaglandin may increase inflammation in the uterus and surrounding organs.

Painful menstrual cramps may also be accompanied by other symptoms like constipation, diarrhea, and nausea.

Types Of Period Pain

There are two types of dysmenorrhea:

• Primary dysmenorrhea: If you have primary dysmenorrhea, painful menstrual cramps are the condition itself. They are not caused by another underlying disorder, start just after your menarche (first menstruation), and accompany every menstrual cycle you experience. The pain from primary dysmenorrhea can range from mild to severe, change over time, and disappear after two or three years. This is the most common form of dysmenorrhea.
• Secondary dysmenorrhea: Secondary dysmenorrhea refers to painful periods caused by another underlying medical condition. This type of dysmenorrhea is usually more intense and lasts longer than normal menstrual cramps, and it can develop at any point in a woman’s reproductive life. Secondary dysmenorrhea accounts for less than 8% of cases of painful menstrual cramps and is most commonly caused by endometriosis.

Pain Thresholds During Menstruation

Several studies have been conducted to determine how the pain threshold changes across the different phases of the menstrual cycle.

Research published in 2003 showed that pain sensitivity levels were significantly higher in the menstrual and premenstrual phases of the cycle, also due to the rise in prostaglandin. Those who experienced intense pain were also more likely to have a passive coping style and catastrophizing thoughts. On the other hand, studies have shown that the highest pain tolerance occurred during the follicular phase.

Additionally, given that sex hormones such as estrogen influence how the brain processes pain signals, the hormonal fluctuations that occur during the menstrual cycle may worsen the painful sensations deriving from other conditions, including migraine.

Conditions Associated With Extremely Painful Periods

If you have recently developed extremely painful periods, you may have secondary dysmenorrhea. This means that simply treating the pain, cramping, and discomfort you experience during the menstrual cycle isn’t enough to regain your pelvic health. Even worse, when left unaddressed, certain conditions that cause painful menstrual cramps can lead to infertility.

Identifying the root cause of your painful periods is the first step to obtaining an accurate diagnosis and selecting an efficient line of treatment. Let’s look at the most common causes of dysmenorrhea below.

Endometriosis

Endometriosis occurs when endometrial growths (lining of the uterus) that thicken and swell during the luteal phase begin to grow outside the uterus, usually on the ovaries, fallopian tubes, pelvic cavity, cervix, vagina, and bladder.

During the different phases of the cycle, this abnormal endometrial tissue behaves just like the endometrium inside the uterus: it is hormone-dependent and grows and thickens during the luteal phase. However, unlike the endometrium, the endometrial implants outside the uterus are unable to leave the body during menstruation.

This leads to an accumulation of endometrial tissue outside the uterus that continues to proliferate, swell, and thicken with each menstrual cycle. Over time, this inflamed tissue can lead to scarring, cysts, adhesions (binding between reproductive organs), and infertility.

Endometriosis is the most common cause of secondary dysmenorrhea. This condition affects over 6.5 million women in the US alone and causes patients to lose an average of six hours a week of productivity.

Endometriosis is also associated with other life-limiting symptoms, including dyspareunia (pain with sexual intercourse), painful bowel movements, excessive bleeding, and gastrointestinal issues. Despite how common and debilitating endometriosis is, 90% of people with this condition report feeling dismissed or disbelieved by their doctors or loved ones.

Premenstrual Syndrome (PMS)

Around 90% of women of reproductive age experience premenstrual syndrome to some extent. This condition is characterized by a range of symptoms, including emotional tension, anxiety, depressed mood, changes in appetite, poor concentration, and changes in libido. PMS also causes joint or muscle pain, headaches, bloating, acne flare-ups, fluid retention, and constipation or diarrhea.

PMS usually occurs one or two weeks before menstruation begins, and the symptoms ease down when your period starts. Although the causes of premenstrual syndrome are not always clear, it is believed that it may arise due to hormone fluctuations and changes in brain chemicals.

Fibroids

Fibroids, also known as myoma, are non-cancerous tumors that develop from muscle tissues within the womb and grow in or around the uterus, cervix, and fallopian tubes.

Fibroids may continue to grow over time and become very large, leading to severe consequences, including secondary dysmenorrhea and painful cramping. Other symptoms that indicate you may have fibroids in your uterus include having a bulging belly (as if you were pregnant), pressure on pelvic organs, frequent urination, and difficult bowel movements.

Although fibroids sometimes don’t cause symptoms, they should not be left unaddressed, as doing so can lead to problems during pregnancy and childbirth.

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is an inflammatory condition that affects a woman’s reproductive organs, including the uterus, fallopian tubes, and ovaries. PID is sexually transmitted and often develops as a complication of other STDs, such as chlamydia. Approximately 2.5 million women in the US have been diagnosed with this condition during their lifetime.

Besides dysmenorrhea, PID can cause pelvic pain, pain during sex, painful urination, bleeding between periods, heavy and painful periods, and abnormal vaginal discharge. Although this condition can be easily treated with a course of antibiotics, it is important not to let PID go unaddressed, as doing so can lead to infertility.

Adenomyosis

Adenomyosis is a condition that occurs when the endometrium (the lining of the uterus) grows into the muscular wall of the uterus. Similarly to endometriosis, these endometrial implants grow and thicken with each menstrual cycle but are unable to leave the body during menstruation. This leads to inflammation, pain, pressure, and an enlarged uterus. If you have adenomyosis, you may also experience dysmenorrhea and excessive bleeding.

Although adenomyosis can affect one in 10 women of reproductive age, the extent and severity of this condition vary from one person to another.

Cervical Stenosis

Cervical stenosis is a condition that causes the narrowing or closing of the passageway located in the lower part of the uterus, known as the cervix. This passageway is used by the menstrual blood to leave the body during menstruation. If the cervix is too small, it can slow down the menstrual flow, which increases pressure, pain, and inflammation inside the uterus during menstruation.

This condition also leads to menstrual abnormalities, infertility, hematometra (the accumulation of blood in the uterus), and, if the menstrual blood flows back into the fallopian tubes and ovaries, endometriosis.