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We’re well past calling menstruation “the curse,” but there is no denying the pain associated with our monthly period — also known as dysmenorrhea.
More than half of women who menstruate experience pain for one to two days each month. While the discomfort is usually mild and manageable, some women experience not only severe pain, but diarrhea, nausea, vomiting, headaches, and dizziness.
Since one of the key signs of fertility in a woman is having a regular and consistent menstrual cycle, some people might equate painful periods with “good fertility.” (Probably because regular, albeit painful, periods aren’t easily forgotten!)
The truth is, dysmenorrhea is an entirely different beast from regular, consistent periods, and, depending on your symptoms, might indicate fertility problems as opposed to fertility health. To understand more about painful periods, and how they could affect your fertility, Rescripted spoke with Jessica Ryniec, M.D., a reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston.
Primary dysmenorrhea vs. secondary dysmenorrhea
Did you know that there are two types of painful periods? There’s primary dysmenorrhea, which is “caused by the chemicals that help the uterus contract,” explains Dr. Ryniec. In other words, typical menstrual cramps that arise before or during your period. The natural chemicals Dr. Ryniec mentioned are called prostaglandins, which are made in the uterine lining and cause the muscles and blood vessels of the uterus to contract. Cramps occur during the first couple of days of the menstrual cycle since the prostaglandin level is at its highest. But the pain tends to lessen as your period progresses and the uterus lining is shed.
Secondary dysmenorrhea, on the other hand, is caused by a disorder in the reproductive organs, such as “endometriosis, adenomyosis, pelvic inflammatory disease, pelvic adhesive disease, intrauterine or cervical scar tissue or inflammatory bowel disease,” says Dr. Ryniec. Pain from secondary dysmenorrhea is usually much worse than primary dysmenorrhea, as it is more severe and lasts longer than normal menstrual cramps.
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Can your period tell you how fertile you are?
While “painful periods are not typically a sign of fertility,” Dr. Ryniec emphasizes that they could signal underlying conditions that “can actually make it harder to get pregnant,” specifically if the patient is suffering from secondary dysmenorrhea: About 30-50% of people with endometriosis experience infertility, and one in 10 women with pelvic inflammatory disease becomes infertile. Anyone living with pelvic adhesive disease, ademnomyosis, or intrauterine or cervical scar tissue, is also at a higher risk for fertility issues.
So if you’re experiencing severe period pain, and plan to have children, you’ll want to see your healthcare provider as soon as possible to rule out any conditions that could have a long-term effect on your reproductive organs. “While mild cramping may be expected and not abnormal due to prostaglandins — which help the uterus contract and stop bleeding – people should not have more significant pain,” says Dr. Ryniec.
Treating painful periods
Primary dysmenorrhea
If you’re suffering from primary dysmenorrhea, there are plenty of treatments at your disposal. Dr. Ryniec recommends heat, exercise, and transcutaneous electrical nerve stimulation (TENS), for those who don’t want to go the medicinal route. If you think you need medication, you should be fine with over-the-counter pain relief: “NSAIDs like Motrin are a great option because they lower prostaglandins which are a common cause of menstrual pain,” says Dr. Ryniec. “Tylenol is a good second option although it does not have as direct an effect. Another option, she says, is to speak with your doctor about birth control that could help alleviate period pain: “Progesterone or combined estrogen/progesterone hormonal medications like the pill, patch, ring, implants, or IUD can be beneficial to those with painful periods that also want contraception.”
Secondary dysmenorrhea
But if you suspect your period pain is more than just cramps and is veering into secondary dysmenorrhea territory, then it’s time to make an appointment with your healthcare provider. “Especially if [your] pain doesn’t respond to pain control measures or interferes with daily activities like school or work,” says Dr. Ryniec. By discussing your symptoms in depth, your doctor will be able to recommend which tests you’ll need to eliminate (or verify) certain diagnoses.
Initial tests will likely include a pelvic exam, which can determine if a medical condition is causing your painful periods. If your physician has ruled out primary dysmenorrhea, then they will probably order additional imaging and diagnostic tests such as an ultrasound, hysteroscopy, or laparoscopy. These will allow your provider to get a more comprehensive look at your reproductive organs.
Should these tests confirm that your painful periods are due to a medical condition, your physician will discuss treatment choices with you, as they vary by diagnosis. Also, if you’re planning on growing your family, be sure to ask your provider if your condition might affect your fertility — and what would be your best course of action for trying to conceive.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Threads.