There are two types of menstrual pains primary and secondary.
In primary menstrual pain, there is no other cause for the pain and the woman is otherwise healthy.
In secondary menstrual pain, the pain is due to other underlying disease or internal or external structural abnormality of the uterus.
During menstruation, there is contraction of uterus to squeeze the old dead endometrial tissue out of the uterus (through cervix) and out of the body (through vagina). Due to these contractions and due to the deprived oxygen supply there is menstrual pain. This is the physiological cause.
Other causes of menstruation pain are stress, anxiety, intrauterine device, pelvic inflammatory disease, sexually transmitted disease, premenstrual syndrome, adenomyosis, cervical stenosis, ovarian cysts, fibroids and endometriosis.
Age less than 20 years, low body mass index, early onset of puberty (age less than 11 years), heavy bleeding during menstruation, long menstrual cycles, sexual abuse, smoking, psychological factors, pelvic inflammatory disease, premenstrual syndrome and having never delivered a baby are the risk factors for menstrual pain.
There may be throbbing, dull, sharp, burning, nauseating or shooting pain in the lower abdomen. The pain may extend to thighs or lower back.
There may be nausea, vomiting, fatigue, fainting, headache or diarrhea. The pain may start with ovulation (as ovulation brings about changes in body) and last up to the end menstruation. The pain may be before the menstruation or during menstruation. There may be heavy bleeding along with menstrual pain. The symptoms subside with end of menstruation.
The condition generally subsides by self care measures like warm showers, regular walking and exercise, vitamin B6, calcium and magnesium supplements; over the counter anti-inflammatory medications, learning relaxation techniques, keeping the legs in elevated position while lying down, sleeping on the sides with knees bent, taking high carbohydrate diet and low salt, sugar, alcohol and caeffine; eating light but frequent meals, applying light circular massage on the lower abdomen and application of heat by heating pads to lower abdomen can help to reduce the pain.
If self care measures do not work then medications are given like antibiotics, anti-depressants, strong anti-inflammatory drugs like diclofenac, strong pain relievers and use of birth control pills.
Surgery is also an option in cases where the pain is not relieved by medications. Surgery may be done for polyps, endometriosis or fibroids.
In some cases the pain is very severe and may affect work. The pain generally relieves by self care measures. The outcome depends upon the cause of the condition.
Complications depend on the underlying cause of the menstrual pain. Scarring of the fallopian tubes, risk of implantation of fertilized egg in the fallopian tubes or infertility are the possible complications due to pelvic inflammatory disease and endometriosis.
If there is excessive vaginal discharge, discharge with foul smell, period longer than a week or period more than a week late and sexually active status then it is better to rush to a health care provider.
