Questions for Your Doctor
What to Ask About Painful Periods
By CAROLYN SAYRE
Confronting a new diagnosis can be frightening, and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.
Is my pain abnormal?
It is not uncommon for adolescents to experience menstrual cramps before or during their period. But if your pain is so severe that it causes you to miss school, prevents you from playing sports or engaging in other activities that you enjoy or interferes with your quality of life in any way, talk to your doctor.
What’s the difference between primary and secondary dysmenorrhea?
There are two types of dysmenorrhea that cause menstrual cramps: primary and secondary. Primary dysmenorrhea, which is commonly found in adolescent girls, means there is no underlying illness that is causing the pain. Secondary dysmenorrhea, which tends to be diagnosed later in life, is caused by a pre-existing medical condition like endometriosis (abnormalities in the lining of the uterus), pelvic inflammatory disease (infection), or uterine fibroids (noncancerous growths in the uterus).
Why are my cramps so painful if there is no underlying medical problem?
During your menstrual cycle, the lining in your uterus produces hormone-like chemicals known as prostaglandins that trigger an inflammatory response and cause the uterine muscles to contract. Research has shown that women with primary dysmenorrhea have higher levels of prostaglandins than those who do not have painful periods.
Are there other symptoms, aside from pain, that are associated with primary dysmenorrhea?
Yes. Prostaglandins can also cause the smooth muscles in the gastrointestinal tract to contract. As a result, women with dysmenorrhea may experience nausea, vomiting and diarrhea during their period. In some cases, dizziness, lightheadedness and headaches may also occur.
How will you determine what type of dysmenorrhea I have?
Doctors generally start by taking a complete medical history. They may also perform a pelvic exam or use an ultrasound to evaluate the reproductive organs. Depending on your medical history and the results of the exam, your doctor may start by treating you for primary dysmenorrhea or recommend additional diagnostic procedures like a laparoscopy — a surgical procedure that lets your physician look at your abdominal and pelvic organs by inserting a small telescope-like instrument into the stomach — to rule out secondary dysmenorrhea. Since only an estimated 5 to 10 percent of women have this type, most doctors will try treating their patients for primary dysmenorrhea first.
Will dysmenorrhea affect my fertility?
Primary dysmenorrhea will not interfere with a woman’s ability to get pregnant or carry a child. But some of the underlying illnesses that cause secondary dysmenorrhea, like endometriosis and pelvic inflammatory disease, may cause infertility or make it difficult to conceive. If you have secondary dysmenorrhea and want to preserve your fertility, discuss your treatment options with a physician.
How do you treat primary dysmenorrhea?
There are several medications that can help. The first line of treatment is typically a nonsteroidal anti-inflammatory drug like Ibuprofen or Naproxen sodium, which block the activity of prostaglandins. If you continue to experience severe cramps on an Nsaid, your doctor will probably suggest that you increase the dosage or switch to a low-dose oral contraceptive, which prevents ovulation and decreases the level of prostaglandins in the body.
Will Nsaids bother my stomach?
They can, particularly in adolescents who smoke or drink caffeine. To reduce stomach irritation, take the medication with food or milk.
How do you treat secondary dysmenorrhea?
It depends on the underlying cause. If you have pelvic inflammatory disease your doctor may recommend a round of antibiotics to treat the infection. Surgical procedures like a myomectomy are often used to remove fibroids or polyps. Depending on the woman’s age, her desire to preserve fertility and the stage of the disease, treatments for endometriosis — the most common cause of secondary dysmenorrhea — range from oral contraceptives to invasive surgery. If you have secondary dysmenorrhea, you should discuss all of your treatment options with your doctor.
Who’s at risk for developing dysmenorrhea?
Any woman who has a menstrual cycle can develop painful periods. Primary dysmenorrhea is most likely to occur in adolescent girls who are under age 20, have never been pregnant, experience heavy or prolonged periods (menorrhagia), suffer from depression or smoke. Secondary dysmenorrhea typically occurs later in life.
Will I always have painful cramps?
It depends what type of dysmenorrhea you have. Primary dysmenorrhea, which typically starts six months to a year after the first menstruation, usually subsides when women reach age 20. In many cases, the cramps also tend to disappear entirely after pregnancy. Secondary dysmenorrhea will continue to cause painful cramps until the underlying medical problem is addressed.
Can exercise help?
Some girls find that aerobic exercise like running, biking and swimming helps relieve menstrual pain. Others say it makes the cramps worse.