When should menstrual pain worry us?

Since a girl has her first menstruation (at approximately 12 years old), until she enters menopause (around 51 years old), women will have about 400 menstrual cycles, that is, during the fertile period the rule will come 400 times.

For what some is somewhat anecdotal, a situation that arises every month without further complication, for others it is accompanied by pain, also known as dysmenorrhea, sometimes so strong that it even affects them in their day to day.

This pain associated with menstruation can be primary and secondary, as indicated by Jose Manuel Traver, a gynecologist at Vithas Nisa Rey Don Jaime Hospital. “In the primary, there is no evidence of pelvic organic disease. During menstruation, the body produces substances called prostaglandins responsible for triggering contractions of the uterus to expel the functional layer of the endometrium in the event that pregnancy does not occur and these are the causes of pain (more release, more pain) " explains Traver.

We talk about secondary dysmenorrhea when that pain is caused by an organic pelvic disease.

According to the expert, dysmenorrhea affects around 40-60 percent of women and in 10 percent of them, it becomes disabling. " The type of pain is spasmodic, with irradiation to the front of the thighs, being maximum on the first day and lasting 1 to 2 days," says Traver.

In addition, in half of the patients, the menstrual pain is accompanied by other conditions. The most common are nausea, vomiting, general fatigue, nervousness, dizziness, diarrhea, back pain, headaches, and even fainting.

What symptoms warn us that the pain is not normal?

There are certain signs that can put us on notice that we are facing secondary dysmenorrhea that may be caused, either by an IUD or by another gynecological problem. Some of the most common would be endometriosis, ovarian cysts, pelvic inflammatory disease, benign tumors (polyps and myomas ), intra-abdominal adhesions or an endocervical canal obstruction.

Those indicators would be:

• When the pain begins to interfere with daily life, it does not improve with the usual treatments and prevents us from carrying out our daily tasks.
   
• When the pain suddenly worsens.
   
• Women over 25 who have severe pain for the first time.
   
• The emergence of fever in periods of pain.
   
• Having pain even when you are not having the menstrual period.

How can we treat menstrual pain?

Before the onset of dysmenorrhea, the woman can apply some measures that mitigate that pain, as Traver explains.

Primary dysmenorrhea

In these cases, the woman should try to relax and learn more, as well as make changes in her diet, for example, reduce caffeine and chocolate; practice physical exercise and apply local heat.

Regarding therapeutic indications, the gynecologist recommends:

• Prostaglandin inhibitors (NSAIDs):
  • Derivatives of phenolates (mefenamic acid).
     
  • Derivatives of propionic acid (naproxen - ibuprofen).
     
  • Acetic acid derivatives (indomethacin).
     
  • Derivatives of enolic acid (pyroxican - tenoxican –eloxican).
     
• Analgesics:
  • Paracetamol (in mild dysmenorrhoea).
     
• Hormonal:
  • Non-steroidal progestogens in the second phase of the cycle
     
  • Hormonal contraceptives (pill, patch, vaginal ring ).

• Alternatives:
  • Glycerin trinitrate patches.
     
  • Calcium blockers (nifedipine - flunaracine).
     
  • Dietary supplements such as omega-3 unsaturated fatty acid

Secondary dysmenorrhea

In these cases, the woman should go to the specialist to diagnose the causative pelvic organic disease and treat it. To confirm the diagnosis, the doctor may request that tests be performed including ultrasound, blood count, vaginal cultures and/or laparoscopy.