Why are periods painful? Causes explained

Menstrual pain, also known as dysmenorrhea, affects the majority of women. For some, the pain is mild and temporary. For others, it becomes a real handicap in their daily lives. Understanding why periods are painful is essential to managing them better. This article explores the main causes of these pains, highlighting the biological processes at work.

What is dysmenorrhea?

Dysmenorrhea refers to pain during menstruation. It mainly manifests itself as cramps in the lower abdomen, but can also be accompanied by backache, headache, nausea and fatigue.

There are two types of dysmenorrhea:

• Primary dysmenorrhea: menstrual pain occurring with the first menstrual period, unrelated to any underlying pathology.
• Secondary dysmenorrhea: pain caused by a gynecological condition, such as endometriosis or uterine fibroids.

Most women suffer from primary dysmenorrhea. These pains are due to natural processes linked to uterine contractions during menstruation.

Biological causes of menstrual pain

Menstrual pain is mainly caused by contractions of the uterus to evacuate the uterine lining (endometrium) when fertilization has not taken place. These contractions are triggered by a hormone called prostaglandin.

1. Prostaglandins

Prostaglandins are chemicals produced by the uterus before and during menstruation. They play a crucial role in triggering uterine contractions. These contractions are necessary to expel the endometrium, but when they are too strong, they cause painful cramps.

The higher the level of prostaglandins, the more intense the contractions and the greater the pain. Some women naturally produce more prostaglandins than others, which explains why some suffer more.

2. Reduced blood flow to the uterus

During uterine contractions, blood flow to the uterus may be temporarily reduced. This lack of oxygen causes pain similar to a muscle cramp. When contractions cease, blood and oxygen return, but the pain may persist.

3. Inflammation

The menstrual process is also linked to the body's natural inflammation. Inflammation can amplify menstrual pain, as it triggers an immune response that increases sensitivity to pain.

Secondary causes of menstrual pain

In some cases, menstrual pain can be a symptom of an underlying pathology. Here are the most common causes:

1. Endometriosis

Endometriosis is a chronic condition in which endometrial-like tissue develops outside the uterus. These tissues can cause intense pain during menstruation, as they react to hormonal changes in the menstrual cycle.

2. Polycystic ovary syndrome (PCOS)

PCOS can disrupt the menstrual cycle, causing irregular and painful periods. This syndrome is often associated with hormonal imbalance, which can aggravate menstrual cramps.

3. Uterine fibroids

Fibroids are benign tumors that develop in the lining of the uterus. They can cause heavy periods and intense pain.

4. Adenomyosis

Adenomyosis is a condition where the endometrium penetrates the muscular wall of the uterus, causing particularly painful periods.

Risk factors for menstrual pain

Some women are more likely to suffer from menstrual pain due to several risk factors:

• Young age: Young women are more often affected by primary dysmenorrhea.
• Family history: Menstrual pain can be genetic.
• Heavy or irregular menstrual cycles: These types of cycles are often more painful.
• Stress and lifestyle: Stress, poor diet and lack of physical activity can aggravate pain.

How can I relieve menstrual pain?

There are many ways to relieve menstrual pain, both natural and medicated:

1. Natural solutions

• Applying heat: Using a hot water bottle or heating patch can relax muscles and reduce cramping.
• Light physical activity: Yoga and stretching can help release tension.
• Food supplements: Magnesium and omega-3s can reduce inflammation.
• CBD: CBD is renowned for its anti-inflammatory and relaxing properties. It can help reduce pain without side effects.

2. Drug treatments

• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs, like ibuprofen, work by reducing the production of prostaglandins.
• Hormonal contraceptives: Some contraceptives can regulate the menstrual cycle and reduce prostaglandin production.

When should you consult a healthcare professional?

If menstrual pain is intense, frequent or interferes with daily activities, it's important to consult a healthcare professional. Certain pathologies, such as endometriosis or fibroids, require medical diagnosis and appropriate treatment.

Warning signs:

• Unbearable pain despite analgesics
• Very heavy bleeding
• Pain that worsens over time
• Pain outside the menstrual period

Summary

Menstrual pain is a common phenomenon, but it shouldn't be seen as inevitable. Understanding the causes of menstrual pain can help you gain a better understanding of your cycle and adopt appropriate solutions to relieve it. It's also essential to break the taboos surrounding menstrual pain and encourage women to seek medical advice in the event of chronic pain.

References

• Dawood, M. Y. (2006). Primary Dysmenorrhea: Advances in Pathogenesis and Management. Obstetrics & Gynecology, 108(2), 428-441. Available here
• Iacovides, S., Avidon, I., & Baker, F. C. (2015). What we know about primary dysmenorrhea today: A critical review. Human Reproduction Update, 21(6), 762-778. Available here
• Morrow, C., & Naumburg, E. H. (2009). Dysmenorrhea. Primary Care: Clinics in Office Practice, 36(1), 19-32. Summaryavailable here
• Deligeoroglou, E. (2000). Dysmenorrhea. Annals of the New York Academy of Sciences, 900, 237-244. Abstractavailable here