Dysmenorrhea (2)

What to Do for Relief?

Consultation and Treatment
Pain During Menstruation: What Can Be Done for Relief?

Dr Claude Allouche, gynécologue
Ahuza Clinic, Raanana
058 726 02 64

 

During the initial episodes of menstrual pain (menstrual cramps), simple measures and early use of nonsteroidal anti-inflammatory drugs (NSAIDs) can be enough to alleviate symptoms. However, in certain situations (pain not relieved by treatment...), medical advice is necessary.

What to Do at the Onset of Menstrual Pain?Dysmenorrhee 2 english

For a first episode of painful menstruation, you can seek advice from your pharmacist. They can recommend an over-the-counter medication to relieve menstrual pain. The most effective medications are NSAIDs, which reduce the secretion of prostaglandins responsible for the pain.

For optimal effectiveness, follow these tips:

  • Don’t wait for the pain to settle in. The treatment is more effective if taken at the first signs of pain.
  • Do not take two NSAIDs at the same time.
  • The treatment duration is short: two to three days are usually sufficient. If the pain persists, consult a doctor.
  • Follow the recommended dosage and take the minimal effective dose.

This treatment is contraindicated in cases of diseases such as digestive ulcers, serious heart, liver, or kidney conditions, and in the case of chickenpox.

Additional Measures to Ease the Pain:

  • Apply a heat source (hot water bottle, warm bath or shower) to your abdomen.
  • Gently massage your abdomen.
  • Stop smoking, as tobacco can worsen the pain.
  • Engage in gentle exercises (walking, swimming, etc.).

When to Consult for Painful Menstruation?

Consult your doctor if the pain:

  • Is not relieved by NSAIDs.
  • Appears in adulthood when your periods were previously not very painful.
  • Worsens or lasts several days, before and after menstruation.
  • Significantly affects your daily life (school or work absenteeism).

Also, consult if you have painful periods accompanied by:

  • Fever,
  • Abnormal vaginal discharge (thick, yellowish),
  • Bleeding between periods (metrorrhagia),
  • Very heavy periods (menorrhagia),
  • Pain during sexual intercourse,
  • Symptoms like irritable bowel syndrome.

Painful Periods: Consultation and Treatment

During the consultation, the doctor will perform a clinical examination. A further evaluation (abdominal ultrasound, etc.) is done if a cause for dysmenorrhea is suspected.

Consultation for Painful Periods

The general practitioner or gynecologist will examine the patient. In cases of dysmenorrhea in a virgin young girl, a gynecological examination is not required.

The additional evaluation may include:

  • Abdominopelvic ultrasound with Doppler, possibly transvaginal (insertion of the probe into the vagina).
  • Abdominopelvic MRI.

Treatment of Dysmenorrhea

The treatment is tailored according to:

  • The intensity of the pain,
  • The patient's age,
  • The nature of the dysmenorrhea: primary (in adolescents) or secondary (related to an underlying disease).

NSAIDs for Menstrual Pain

Nonsteroidal anti-inflammatory drugs (ibuprofen, flurbiprofen) stop the production of prostaglandins, thus reducing uterine contractions and pain.

For optimal effectiveness:

  • Take the treatment at the first signs of pain.
  • Do not combine several NSAIDs.
  • Limit the duration of treatment to two or three days.
  • Respect the prescribed dosages.

This treatment is contraindicated in cases of specific diseases (ulcers, heart, liver, or kidney diseases) or chickenpox.

If NSAIDs Are Not Enough...

If NSAIDs do not provide sufficient relief, other options are available:

  • Combined estrogen-progestin oral contraceptive: This reduces menstruation and uterine contractions. The contraceptive can be taken continuously to suppress periods.
  • Progestin-only oral contraceptive: This can suppress periods in certain cases.
  • Progesterone IUD: This releases progesterone in the uterus, reducing pain.

Treatment for Underlying Conditions

If a disease is detected (endometriosis, fibroids, uterovaginal malformation, etc.), specific treatment will be implemented to address the cause and reduce menstrual pain.

Source: Ameli.fr