Painful Periods: Understanding the Norm and Identifying Pathology

Many women experience discomfort during their menstrual cycles. While some may feel only mild discomfort, others endure such intense pain that it significantly impacts their emotional well-being, productivity, and overall quality of life for several days each month. This raises the question: Are these symptoms a pathology, and can painful periods be alleviated?

Understanding the Problem

Severe pain accompanying menstruation is not normal and requires thorough examination. This condition is likely algodysmenorrhea, a menstrual disorder characterized by painful cramps.

What is Algodysmenorrhea?

Algodysmenorrhea (also known as algomenorrhea or dysmenorrhea) is quite common, affecting between 43% and 90% of women. Specialists categorize it into primary and secondary algodysmenorrhea.

Primary Algodysmenorrhea

Primary (or functional) algodysmenorrhea is a pathological process that begins with the onset of menstrual function or within 1.5–2 years after the establishment of ovulatory cycles. It is often caused by underdevelopment (genital infantilism) or abnormal positioning of the uterus and other anatomical features of the female reproductive organs.

Secondary Algodysmenorrhea

Secondary algodysmenorrhea is typically caused by various underlying conditions, sometimes being their only symptom. These conditions include endometriosis, uterine and vaginal malformations, inflammatory diseases, tumors of the uterus and appendages, fibroids, cysts, and adhesions in the pelvic area.

Hormonal Factors

Algodysmenorrhea can also be triggered by hormonal imbalances, specifically disruptions in the natural equilibrium between progesterone and prostaglandins. Prostaglandins regulate uterine contractions, and when their levels are elevated, the force of these contractions increases, leading to more intense pain.

Other Contributing Factors

Painful periods can also be associated with the presence of an intrauterine device (IUD), not only due to the foreign body but also because the IUD can increase prostaglandin levels. Young, nulliparous women (especially those with an abnormally positioned uterus) and women with heightened central nervous system excitability are more susceptible to this condition. Additionally, algodysmenorrhea often has a hereditary component.

Symptoms

The primary symptom of algodysmenorrhea is lower abdominal pain during menstruation, which can sometimes radiate to the lower back. Primary algodysmenorrhea typically manifests as cramping pains, while secondary algodysmenorrhea is characterized by constant, dull aches.

The intensity of the pain can range from mild discomfort to severe debilitation, significantly reducing the quality of life. Algodysmenorrhea is often accompanied by conditions such as vegetative-vascular dystonia, mitral valve prolapse, myopia (nearsightedness), and scoliosis.

Degrees of Severity

Based on the symptoms, the severity of algodysmenorrhea can be classified into four degrees:

Degree 0: Pain-free menstruation with no impact on daily activities.
Degree 1: Mild pain during menstruation, rarely leading to reduced activity.
Degree 2: Reduced daily activity, but pain is effectively managed with analgesics.
Degree 3: Significantly reduced activity, accompanied by symptoms of autonomic disorders such as headaches, fatigue, nausea, and diarrhea. Analgesics are generally ineffective.

According to statistics, 45% of patients experience a severe form of the disorder, 35% have a moderate form, and 20% have a mild form. Additionally, algodysmenorrhea can lead to irritability, depression, sleep disturbances, general weakness, sweating, bloating, and edema.

Diagnosis

The diagnosis of algodysmenorrhea is based on a comprehensive examination. It is essential to rule out causes of pain unrelated to menstruation, such as infections, chronic inflammatory processes in the pelvic organs, and diseases of the uterus and appendages.

Patients typically undergo a complete blood count, hormone level tests, bacteriological examinations of cervical and vaginal discharges, and ultrasound imaging.

Treatment

Treatment for algodysmenorrhea should be comprehensive, aiming to eliminate pain, normalize the menstrual cycle, and improve the state of the autonomic nervous system and psycho-emotional background. It should also address or alleviate the conditions that led to secondary algodysmenorrhea.

Treatment options include hormonal and nonsteroidal anti-inflammatory drugs, magnesium salts, and vitamins. To normalize the functions of the central nervous system, physiotherapy, acupuncture, massage, and mild herbal sedatives may be prescribed.

A healthy lifestyle is crucial for managing symptoms of algodysmenorrhea. This includes maintaining a balanced work-rest schedule, engaging in moderate physical activity (such as therapeutic exercises), and avoiding harmful habits.

Proper, balanced nutrition is also vital. In the premenstrual days, it is recommended to increase the intake of easily digestible, vitamin-rich foods (such as vegetables and fruits) and foods containing polyunsaturated fatty acids (such as fish and seafood). During this period, it is advisable to avoid dairy products and caffeine-containing beverages, opting instead for herbal teas.

If the pain is caused by a specific position of the uterus that hinders the outflow of menstrual blood, the organ’s position may change after childbirth, leading to a more physiological alignment and the cessation of pain.