Understanding Primary Dysmenorrhea in Teenagers

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Overview

If you have painful periods you are not alone. It is thought that up to 90 percent of women experience some pelvic discomfort during their menstruation. But sometimes that pain can be very intense.

If you are in your teens or early 20's and you are having very painful periods you likely have a condition known as primary dysmenorrhea.

Painful periods are the leading cause of missed school days in the U.S.

What Is Primary Dysmenorrhea?

Dysmenorrhea is the medical term used to describe painful periods.

There are two distinct types of dysmenorrhea. Secondary dysmenorrhea describes a painful period that is caused by an underlying pelvic condition like fibroids or adenomyosis. This type of period pain typically develops after years of relatively mild periods.

Primary dysmenorrhea is used to describe the cramping pain that happens during your period when there is no other pelvic condition that could cause the pain.Typically primary dysmenorrhea starts within the first year or so after you start getting your periods regularly.

Symptoms

The pain of primary dysmenorrhea is pretty typical. It usually starts within 12 hours before or about 6 hours after you start your period. The pain is usually the worst on your heaviest flow day. But in some young women, the pain can last for up to 3 days.

The pain of primary dysmenorrhea is usually the same and predictable from period to period.

It is most often described as a cramping pain that starts in the middle of your lower abdomen. The pain will often spread to your lower back and even to your upper thighs as a dull and constant or throbbing discomfort.

You may have some other unpleasant symptoms that go along with the pain of primary dysmenorrhea.

These symptoms may include:

It is thought that these symptoms are caused by the release of prostaglandins a natural chemical in your body that is also responsible for the pain of primary dysmenorrhea.

Causes

The lining of your uterus produces natural chemicals called prostaglandins.

Some of these prostaglandins cause the muscle and the blood vessels in your uterus to contract. When the muscle and the blood vessels contract it temporarily decreases the blood flow to the uterus. This decreased blood flow is called ischemia. In the uterus, the ischemia is short lived and comes in waves as the uterus contracts. But these changes are similar to what happens during a heart attack. The decreased blood flow to the uterus is a part of what causes the pain of primary dysmenorrhea.

The amount of prostaglandins produced by the lining of your uterus is highest the day before and during the first day or two of your period when your menstrual flow is the heaviest. That is why your symptoms are these are the worst during these days.

When to See a Doctor

First of all, you should not suffer from painful periods. Remember you are not alone.

Studies suggest that about 15 percent of teenage girls report intensely painful periods. In fact, primary dysmenorrhea is the leading cause of recurring missed school days among teenage girls in the United States. There is no reason for you to miss out on school, work or other activities because of painful periods. It is a good idea to discuss your periods with your doctor if they are interfering with your regular activities either because of pain, heavy bleeding or both.

What to Tell a Doctor

Before you talk to your doctor about your painful periods it is a good idea to think about how you will describe your symptoms.

Most doctors will ask you questions to help them figure out what is causing your pain so they can make the right diagnosis. Think about how you would answers the following questions.

  • How old were you when you started having your period?
  • Do your periods come every month?
  • How many days do you bleed for?
  • When was your last period?
  • How long after your very first period did your periods become painful?
  • When does the pain start in relationship to the start of your period?
  • Where is the pain located?
  • Does it move to your lower back or your upper thighs?
  • Do you miss school or work because of period pain?
  • Have you started having sex yet? If yes, is sex painful?
  • Are you using any contraception?
  • Do you have any other unpleasant symptoms during your periods like diarrhea or nausea?
  • Did you mother or any other women in your family have painful or problem periods?
  • What if anything makes the pain better?

Maybe even consider writing down your answers to these questions and bring them with you to your doctor's appointment. Being prepared and working with your doctor will help you to get the correct diagnosis and help you feel better faster.

Diagnosis

Contrary to popular belief pelvic exams aren’t really that bad. But depending on the information you provided to your doctor you may not even need to have a pelvic exam for your doctor to make the diagnosis of primary dysmenorrhea.

In fact, it is unlikely that you will need a pelvic exam if you are a teen, have never been sexually active and your symptoms are typical of primary dysmenorrhea.

If you have started having sex your doctor will likely want to perform a pelvic exam. It is important to make sure that a pelvic infection caused by a STI like chlamydia or gonorrhea making your painful periods worse.

If your pain does not go away after a few months of medical treatment or if the answers to your questions suggest and underlying problem your doctor will likely suggest a pelvic exam even if you have not started having sex yet.

No additional testing or pelvic imaging is needed to make a diagnosis of primary dysmenorrhea. However, if your doctor thinks that your painful periods may be due to an underling pelvic condition meaning that you have secondary dysmenorrhea, your doctor will likely suggest additional testing.

Treatment

When thinking about treatment options it is important to remember that the natural chemicals called prostaglandins that are produced in the lining of the uterus are responsible for the symptoms of primary dysmenorrhea.

The goal of medical management is to decrease the production of prostaglandins in the lining of your uterus.  There are two types of medications that do this, non-steroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptive medications.

There are several different types of NSAIDs. Most doctors suggest starting with ibuprofen, which is available over the counter. The usual effective dose of ibuprofen is 600 mg and you can take that dose every 6-8 hours.  Sometimes you need to use a different or a stronger NSAID to block the prostaglandins. But, you have to be really careful when you use NSAIDs because they can cause damage to the lining of your stomach that can lead to gastritis and gastric ulcers. You should never take NSAIDs on an empty stomach.

All of the hormonal contraceptive options will thin out the lining of your uterus and by doing so will reduce prostaglandin production. In general, using one of the hormonal contraceptives is a very effective way to treat your painful periods.

In addition to medications there are some lifestyle changes that can help reduce menstrual pain.

Getting adequate aerobic exercise on a regular basis has been shown to reduce painful periods.

There are also some dietary changes that have been shown to help. You should try and eat more foods rich in omega -3 fatty acids such as salmon, walnuts and avocados.  Also foods rich in Vitamin B have been shown to help reduce menstrual cramping. If you eat a well balanced diet you are likely getting enough Vitamin B. But often teens don’t have the best diet so taking a Vitamin B complex supplement can be helpful.

A Word From Verywell

Remember you don't have to settle for painful periods. Don't be embarrassed to discuss your periods with your doctor. By making simple lifestyle changes and trying the right medications you can live very well with a diagnosis of primary dysmenorrhea.

Source:

French, L. (2015). Dysmenorrhea. American Family Physician. 71(21), 285-291

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