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If you’ve been suffering with painful periods, you might think your pain is a natural part of menstruation. While menstrual cramps are normal, excessive pain during menstruation can be a sign that something more is going on. Below, we discuss some of the conditions that can cause unusually painful periods.
Fibroids
Uterine fibroids, also called leiomyomas, are benign tumors that grow in the muscle tissue of the uterus. They’re extremely common, affecting an estimated two thirds of women by the time they reach age 50, and they disproportionately affect women of color: black women are diagnosed with fibroids at three times the rate of white women. Although fibroids are benign and often cause no symptoms, they sometimes lead to heavy cramping and bleeding during periods. Associated blood loss can cause anemia, and cramping can significantly impede daily activities. Fibroids can also interfere with pregnancy.
Diagnosing & Treating Fibroids
Doctors most often use ultrasound to identify fibroids, but if ultrasound doesn’t provide enough information, then they may order additional imaging techniques, such as MRI, sonohysterography, hysterosalpingography, or hysteroscopy.
Often, fibroids require no treatment. Even if they cause some symptoms, the recommended approach may be watchful waiting, as these tumors tend to shrink when hormone levels drop in menopause, and symptoms may subside. In the meantime, the doctor may order labs to check for anemia and suggest using NSAIDs such as ibuprofen or naproxen sodium for pain as well as non-drug tactics like
- Exercise
- Stress reduction
- Hot baths
- Supplementing with omega-3 fatty acids, magnesium, or vitamins E, B-1, and B-6
- Acupuncture
- Transcutaneous electrical nerve stimulation (TENS)
When these approaches fall short, more aggressive treatment may be recommended. These may include medications to block hormones or reduce bleeding. Some women undergo surgical removal of fibroids (myomectomy) or of the entire uterus (hysterectomy), however, less invasive procedures may provide relief. Uterine fibroid embolization, for example, is a minimally invasive procedure in which a radiologist uses fluoroscopy (a moving X-ray image) to inject blocking agents into the arteries that provide blood to the tumors. Radiofrequency ablation is another minimally invasive option, in which the doctor uses RF energy to destroy and shrink tumors. Less invasive treatments tend to be associated with significantly fewer complications and quicker recovery times.
Pelvic Congestion Syndrome
Pelvic congestion syndrome (PCS) arises as a result of varicose veins in the pelvic region. This can occur following pregnancy, which alters the structure of the pelvis, increases the body’s fluid volume, and raises the amount of estrogen in the body, which can weaken blood vessel walls. As a result, valves in the veins weaken, allowing blood to pool and causing pressure and pain. Multiple pregnancies increase the risk of PCS. Other risk factors for PCS include hormonal irregularities, polycystic ovaries, and retroverted uterus. Like fibroids, PCS can cause heavy bleeding and cramping during periods. It can also cause pain during intercourse, pain in the back or hips, increased urination, irritable bowel, swelling of the vulva or vagina, and abnormal vaginal discharge.
Diagnosing & Treating PCS
Diagnosis of PCS usually begins with ultrasound, but it may also include venography or MRI. Doctors typically recommend medication to relieve pain. Additionally, pelvic vein embolization is a minimally invasive procedure that provides relief for many patients. In this procedure, the radiologist uses X-ray to guide a thin catheter to the affected veins, where it uses tiny metal coils and a sclerosing agent to clot the blood and seal the vein.
Endometriosis
Endometriosis affects about 10% of women, typically arising in their 30s or 40s. In women with endometriosis, the tissue that forms the uterine lining grows outside the uterus, such as on the bladder, ovaries, or fallopian tubes. The tissue responds to estrogen by growing and bleeding as the uterine lining does during menstruation. This can cause scar tissue formation, inflammation, and pain, which can be worse during periods, intercourse, bowel movements, or urination, depending on the tissue’s location.
Diagnosing & Treating Endometriosis
Endometriosis is diagnosed with laparoscopy, a minimally invasive surgical procedure that uses a small camera. Treatments often include pain medication, hormonal medications, and/or surgery to remove the abnormal tissue. Taking hormonal medications following surgery may reduce the chance of recurrence.
Adenomyosis
In adenomyosis, which most frequently affects women in their 40s and 50s, the tissue that forms the uterine lining grows into the muscle walls of the uterus. In addition to intense menstrual cramping, adenomyosis can cause heavy bleeding during periods, chronic pelvic pain, pressure, or tenderness, and pain during intercourse.
Diagnosing & Treating Adenomyosis
A doctor may suspect adenomyosis based on a pelvic exam or imaging such as ultrasound or MRI. An endometrial biopsy may be used to rule out a more serious condition; however, the only way to confirm a diagnosis of adenomyosis is by examining the uterus after a hysterectomy. Adenomyosis often resolves with menopause. In the meantime, doctors often recommend pain and hormonal medications or, in severe cases, hysterectomy.
The above are just a few of the conditions that can cause persistently painful periods. If your period pain is getting in the way of your everyday activities or you notice it becoming worse, don’t suffer in silence. Consult with your doctor to find out if there is a treatment available that could alleviate your pain.
The above are just a few of the conditions that can cause persistently painful periods. If your period pain is getting in the way of your everyday activities or you notice it becoming worse, don’t suffer in silence. Consult with your doctor to find out if there is a treatment available that could alleviate your pain.
Resources
Endometriosis. ACOG.org. Updated February 2021. Accessed June 14, 2022. https://www.acog.org/womens-health/faqs/endometriosis.
Mostafavi B. Understanding Racial Disparities for Women with Uterine Fibroids. UofMHealth.org. Published August 12, 2020. Accuessed June 14, 2022. https://labblog.uofmhealth.org/rounds/understanding-racial-disparities-for-women-uterine-fibroids.
Ovarian Vein Embolization. Radiologyinfo.org. Reviewed July 30, 2021. Accessed June 14, 2022. https://www.radiologyinfo.org/en/info/ovariveinembol.
Uterine Fibroids. MayoClinic.org. Published September 16, 2021. Accessed June 14, 2022. https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288.
Venography. Radiologyinfo.org. Reviewed February 8, 2021. Accessed June 14, 2022. https://www.radiologyinfo.org/en/info/venography.
Young B. What Is Pelvic Congestion Syndrome? Healthline.com. Reviewed March 30, 2022. Accessed June 14, 2022. https://www.healthline.com/health/pelvic-congestion-syndrome.
