Overview Causes Symptoms Treatment
What is dysmenorrhea (menstrual pain)?
Dysmenorrhea is the medical term for pain related to menstruation, characterized by severe cramps in the lower abdomen, back, or thighs, often with nausea, fatigue, or headaches, affecting up to 90% of menstruating individuals, especially teens and young adults.
Common Related Conditions
Causes of dysmenorrhea (menstrual pain)
Menstrual pain is categorized as primary in 90% of affected women due to prostaglandins causing uterine contractions, common from adolescence. Secondary dysmenorrhea caused by underlying conditions like endometriosis, fibroids, or PID, often with a later onset, affects 10%. Management includes NSAIDs, hormonal birth control, and self-care like heat, but severe, new, or worsening pain warrants a doctor’s visit to rule out underlying causes.
Primary dysmenorrhea begins with a woman’s first menstrual cycle and may recur until menopause. It can occur due to tiny internal adhesions that can form in the female reproductive tract. However, it can appear when there is no pelvic pathology. Secondary dysmenorrhea has a later onset and may first appear due to pelvic adhesions that form after identifiable conditions such as surgery, endometriosis, inflammation (PID), infection, or trauma. Secondary dysmenorrhea has also been linked to structural abnormalities inside or outside of the uterus, such as an intrauterine device (IUD).
Menstrual pain patterns may vary widely from person to person. Pain may increase or decrease at night, may or may not be continuous, and may intensify suddenly. It can feel like a weighty, pulling sensation and may radiate to the lumbar, sciatic, pelvic floor, or groin areas. The pain may be accompanied by nausea, vomiting, diarrhea, migraines, fainting, fatigue, or dizziness. The main symptom of dysmenorrhea is pain concentrated in the lower abdomen and pelvis. Pain can radiate into the thighs and lower back.
The initial onset of primary dysmenorrhea may result from certain chemical or hormonal conditions. For example, hormones such as prostaglandin and arachidonic acid are known to cause uterine contractions. Prostaglandins are released during menstruation due to the periodic destruction of endometrial cells and the release of their contents. As the menstrual period progresses, the levels of prostaglandins decrease, thus lowering the pain.
The pain can be caused or exacerbated by spasm, endometriosis, tightness, or adhesions. Adhesions affect the ligaments, fascias or connective tissues that attach the uterus to surrounding structures. Women with secondary dysmenorrhea may also experience infertility due to restricted mobility of the reproductive and urogenital structures as a result of adhesions.
Adhesions can accompany or cause dysmenorrhea as the body reacts to trauma, inflammation, infection, surgery, or chronic spasm. Adhesions are composed of tiny but strong strands of collagen that form around traumatized tissue to help it heal. Acting like glue, the adhesions surround and isolate the injured tissue while it heals from infection, inflammation, surgery, or trauma.
Once the healing process is complete, the adhesions remain in the body as tiny but powerful straitjackets, binding structures that should be mobile. These adhesions can attach to pain-sensitive structures in the pelvis, causing pain. Wherever they form, adhesions join structures with strong glue-like bonds that can last a lifetime.
Symptoms of dysmenorrhea (menstrual pain)
- Cramping or throbbing pain in the lower abdomen or pelvis
- Pain that radiates to the lower back or thighs
- Nausea or upset stomach
- Diarrhea or loose stools
- Headache
- Fatigue or low energy
- Lightheadedness
- Bloating or abdominal pressure
- In severe cases, vomiting or dizziness
Treatment for dysmenorrhea (menstrual pain)
We know pelvic adhesions well. The molecular bonds (crosslinks) that attach tiny collagen fibers to their neighbor appear to dissipate or dissolve with certain site-specific manual therapy techniques. Clear Passage® physical therapists’ pioneering work has been shown to free abdominal and pelvic adhesive bonds and return structures to a more functional, pain-free state, without surgery or drugs. Published studies of women with endometriosis show decreased menstrual pain in 79% of women and decreased intercourse pain in 93% of women treated with Clear Passage® therapy (Journal of Endo, 2011 and following).
Other Treatment Options (Surgery, Drugs)
- NSAIDs or over-the-counter pain relievers
- Hormone therapy
- Exercise
Until recently, lysis (burning or cutting through adhesions during laparoscopy or laparotomy) was the only option to remove adhesions in the pelvis. While lysis of pelvic adhesions can be effective, surgery has some risks and drawbacks:
- It carries risks from anesthesia and infection
- Surgeons can mistakenly cut or burn nearby or underlying structures.
- Despite the best skills of the finest surgeon, the body creates more abdominal adhesions as it heals from the very surgery designed to remove them.
A five-decade study in Digestive Surgery showed that 55% to 100% of women develop adhesions following pelvic surgery. (Liakakos et al,, 2001) Another very large study reported that 35% of all open abdominal or pelvic surgery patients were readmitted to the hospital more than twice to treat post-surgical adhesions during the 10 years after their original surgery. (Ellis et al., 1999) Thus, pelvic surgery itself has been implicated as a major cause of adhesion formation, and many patients become trapped in a cycle of surgery-adhesions-surgery, with no end in sight.
Condition Specific Disclaimer:
The information provided about dysmenorrhea (menstrual pain) is for educational purposes only and is not intended to replace medical advice from your physician. Our therapy is a non-invasive manual approach that may be considered as a complementary option after consultation with a patient’s medical team. Our therapy is a non-invasive manual approach that may be considered a complementary option after consultation with a patient’s medical team. Individuals experiencing severe or persistent menstrual pain should seek medical evaluation to determine the underlying cause and appropriate treatment plan and to determine the underlying cause of symptoms. Contact Clear Passage® and fill out a medical history form to determine if therapy is an appropriate part of your overall treatment plan.
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