Painful Menstrual Periods (Dysmenorrhea)

Many women have pain during their periods.  If this begins during teenage years, there is probably no underlying illness involved.  If it begins after 25, weโ€™d have concern for a specific cause. If periods are especially heavy see also our topic Heavy Menstrual Periods.

Painful periods are rarely if ever due to anything that would be an emergency. Some causes may be more serious than others (see table). However, if a woman has brand new onset of low abdominal pain during her period, see our topic Lower Abdominal Pain.

Causes of Painful Menstrual Periods

Mainly <25 y.o.Mainly > 25 y.o.Any Age
โ€ข Congenital Obstructions xxxx(occurring from birth)

x
x
โ€ข Uterine Fibroids (aka xxxxleiomyomas)
โ€ข Adenomyosis
โ€ข Rare Tumors
โ€ข Chronic Pelvic Inflammatory xxxxDisease (PID)
โ€ข Endometriosis
โ€ข Intra-Uterine Devices (IUD’s)
โ€ข Cervical Stenosis (tight)

1.  Perform a Pelvic Exam (although it’s usually normal)

  • Tenderness of tubes suggests Infection (P.I.D.) โ†’  treat with antibiotics
    • Chronic P.I.D. is often non-tender
  • Large uterus suggests Fibroids, maybe Adenomyosis  โ†’  Ultrasound for diagnosis
  • Certain physical findings might suggest Endometriosis
  • A Teenager may have Congenital Abnormalities (from birth)
  • We find a tight cervix (Cervical Stenosis) when attempting a Pap test

2. Obtain an Ultrasound

  • Easily diagnoses Fibroids, maybe Adenomyosis, rarely Endometriosis, Tumors (very rare)
  • Possibly diagnose congenital Obstructions in Teenagers with extreme menstrual pain

3.  If No Diagnosis by pelvic exam and ultrasound:

  • Reassure patient that tests are normal
  • If patient using an IUD, consider changing to other birth control method
  • If symptoms are disabling, and suggest possible Endometriosis, prescribe birth control pills.ย  If no help, refer to Gynecology for laparoscopy.
  • Chronic P.I.D. may require laparoscopy for diagnosis
  • Teenagers with disabling symptoms ย โ†’ refer to Gynecology to rule out Congenital Obstructions

See Painful Menstrual Periods โ€” Full Text for more in-depth explanations and discussion.

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