When are period cramps ‘too much’ and when should you see a doctor? OBGYN answers

Period cramps, medically known as dysmenorrhea, is among the common and uncomfortable aspects experienced by women during “that time” of the month.

According to obstetrician-gynecologist Dr. Viktoria Ines Matibag, dysmenorrhea happens because the uterus contracts when the endometrial lining—which grows thicker to prepare for a pregnancy—is shed during menstruation.

Matibag said dysmenorrhea has two types: primary and secondary.

There is primary dysmenorrhea, which happens when the cause of painful menstrual cramps is an increase in prostaglandins, a group of lipids that our bodies make at sites of tissue damage or infection.

Matibag said prostaglandins help contract the uterine muscles, which can be “perceived as pain by the body.”

Meanwhile, secondary dysmenorrhea happens when there are other medical conditions that cause painful menstrual cramps.

This includes pelvic endometriosis, adenomyosis, myomas, ovarian cysts, or pelvic congestion, among others.

Matibag said that some women experience cramping not just on menstruation days but also even before or after the cycle.

“Menstruators with secondary dysmenorrhea may experience pelvic pain even without menses due to whichever medical condition they have,” she said.

Among the at-home remedies Matibag recommends are taking pain relievers around the clock like non-steroidal anti-inflammatory drugs, exercising for at least 30 minutes on most days of the week, and using warm compresses in the pelvic region.

But she also advised that when the period pain is “debilitating enough to cause disruption in a menstruator’s daily life, they should seek [consultation] with an OBGYN.”

“When they have to skip school or work, can’t get out of bed to do activities of daily living, and pain medication [is] not working to lessen the pain, these are some reasons why they should seek consultation with a doctor,” she said.

Severe period pain is diagnosed through a basic work-up, which includes a transvaginal or transrectal ultrasound to view the pelvic organs.

“If inconclusive and there is suspicion of deep infiltrating pelvic endometriosis or other abdominal conditions that causes the severe period pain, an MRI may be done,” she said.

Moreover, treatment depends on what the cause of the severe period cramps is.

“We can prescribe combined oral contraceptives containing estrogen and progesterone if you have primary dysmenorrhea, as this is known to relieve symptoms in around 90% of patients, through decreasing arachidonic acid, which is the precursor of prostaglandin, in the endometrium,” she said.

“If the patient has endometriosis or adenomyosis, then we prescribe progestins like dienogest continuously to suppress menstruation to help the endometriotic lesions to heal,” she added.

These oral medications can cost from P800 to P2,000 per month.

“There are other medical conditions that may also need surgical intervention if the OBGYN assesses that this is necessary,” she said.

—MGP, GMA Integrated News