Hi doc, what causes painful menses and what can I do about it?

Menstrual pain or dysmenorrhea may have different causes depending on the type. Primary dysmenorrhea refers to the menstrual pain that is not associated with any pelvic or medical disease but solely due to the natural process associated with menstruation. It is a normal feature of many but not all ovulatory cycles. It is a cyclical pain that is usually felt on the first two days of the menstrual cycle, worse at its onset but gradually eases off, stopping completely prior to the end of menses. It normally reduces in intensity as one gets older and often after child birth. Secondary dysmenorrhea on the other hand refers to any other type of menstrual pain other than that described earlier and is basically due to pelvic diseases such as uterine fibroids, endometriosis and pelvic inflammatory diseases among many others. It may present as the presence of a new onset menstrual pain in a woman who has never felt any menstrual pain, or as worsening pain in a woman with primary dysmenorrhea or as any other pattern of menstrual pain, different from the typical primary dysmenorrhea such as pain at the end of the mentrual flow or in between menstrual cycles.

While primary dysmenorrhea has no specific treatment other than the use of analgesics e.g. ibuprofen, feldene, diclofenac and mefenamic acid and hormonal contraceptives, which are drugs that prevent ovulation e.g. oral contraceptive pills (OCP) and Mirena intrauterine device system, secondary dysmenorrhea is best treated by treating its primary cause. For more information on the types and treatment of menstrual pain, kindly go through the articles PRIMARY DYSMENORRHEA and SECONDARY DYSMENORRHEA or CHAT WITH OUR CONSULTANT.

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