Painful Menstruation Often Ignored By Patients and Caregivers Alike

Women suffering from primary dysmenorrhea — painful menstruation in the absence of any sort of pelvic pathology – are unlikely to think much of it, chalking it up to a normal part of the menstrual cycle. A review in Human Reproduction Update, however, suggests that health professionals and pain researchers also generally ignore the condition.

The gynecological condition is not rare; it can impact half to as much as 95% of menstruating women. This high prevalence perhaps explains the near indifference to it. But, the study authors noted, primary dysmenorrhea is often debilitating; it can bring severe pain and major consequences on mood, quality of life, and even sleep quality in patients suffering with the condition.

The review included a comprehensive literature search on primary dysmenorrhea using PubMed, Google Scholar and the Cochrane Library. Full-text manuscripts published as far back as World War II, up to 2015, were reviewed for relevancy. The review found that women with dysmenorrhea, compared to women without dysmenorrhea, have greater sensitivity to experimental pain both within and outside areas of referred menstrual pain.

“Importantly, the enhanced pain sensitivity is evident even in phases of the menstrual cycle when women are not experiencing menstrual pain, illustrating that long-term differences in pain perception extend outside of the painful menstruation phase,” the authors explained, adding that this enhanced pain sensitivity may increase susceptibility to other chronic pain conditions in later life. Dysmenorrhea is known to be a risk factor for fibromyalgia, for example. This potential for the development of additional chronic pain disorders elevates concern about under-treatment of menstrual pain from a concern that is only felt several days per month to one that has larger implications for overall, long-term health.

Further, dysmenorrheic pain has an immediate negative impact on quality of life. As with other pain conditions in which the pain can be severe, women with primary dysmenorrhea have a significantly reduced quality of life, poorer mood, and poorer sleep quality during menstruation compared with their pain-free follicular phase, and compared with the menstruation phase of pain-free control women.

Treatment for primary dysmenorrhea is generally effective, and thus, it hasn’t changed in decades. First-line therapy continues to be non-steroidal anti-inflammatory drugs, which are effective in relieving daytime and night-time pain and have a generally positive adverse event profile.

The researchers suggest that further studies could determine whether more frequent treatment of dysmenorrheic pain could alleviate the prevalence of conditions such as fibromyalgia. Beyond promoting treatment, the study authors posit that future research should examine whether it is possible to prevent the development of severe dysmenorrheic pain in adolescent girls.