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You may have heard of dysmenorrhea — the technical term for painful cramps or period-related symptoms that bubble to the surface once a month. Depending on the severity of your symptoms, you may be able to manage them with some lifestyle adjustments or by turning to your OB/GYN for added support.
According to the American College of Obstetricians and Gynecologists, about half of women live with dysmenorrhea in some capacity. But not all women have dysmenorrhea that’s caused by the same triggers.
Primary vs. secondary dysmenorrhea
Primary dysmenorrhea is related specifically to a menstrual period, occurs before or during the period, and subsides after you’ve stopped bleeding. On the other hand, secondary dysmenorrhea can be triggered by a range of conditions and its symptoms stick around for longer than regular menstrual cramps would. It’s also noteworthy because instead of an onset when you first get your period, secondary dysmenorrhea typically develops later in life.
According to Dr. Norbert Gleicher, MD, Medical Director and Chief Scientist at The Center for Human Reproduction, understanding secondary dysmenorrhea is an exercise in accepting how personal and unique a diagnosis it can be.
“It may be difficult to know what causes dysmenorrhea because we still do not understand well what causes dysmenorrhea and there are several different presumed causes,” adds Dr. Gleicher. “The most frequent one associated [with it] is endometriosis, but dysmenorrhea may also be associated with other pelvic pathology.”
Other conditions that are typically associated with secondary dysmenorrhea
While endometriosis is cited as one of the most common culprits behind secondary dysmenorrhea, according to the ACOG, other pelvic conditions can trigger its symptoms.
According to Dr. Barad, Attending Physician at Mount Sinai West and Director of Assisted Reproductive Technology at The Center for Human Reproduction, some of these conditions include fibroids, adenomyosis, or uterine polyps.
“All of these conditions would be associated with a change in menstrual blood flow,” explains Dr. Barad. “Normal menstrual flow is dark and fluid with the above conditions menstrual flow is often bright red with [the] passage of large blood clots and associated with significant cramping.”
Prepping for a doctor’s visit if you think you have secondary dysmenorrhea
When asked if there were any red flags women should look out for as signs they may have secondary dysmenorrhea, Dr. Gleicher shared, “Believe me, they know when they have dysmenorrhea!”
Ahead of any doctor visits, trust your gut, what you know of your symptoms, and your pain levels.
There are a series of tests that can help your care team better understand any underlying conditions that may be causing your secondary dysmenorrhea.
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According to Dr. Gleciher, you can expect three different diagnostic approaches depending on the severity of your symptoms. These include a pelvic exam, an ultrasound, and a laparoscopy and hysteroscopy.
“A pelvic exam will identify tenderness, irregularities of the size and shape of the uterus,” explains Dr. Barad. “[While] transvaginal sonogram can identify fibroids, uterine polyps, and ovarian cysts which may be associated with endometriosis. It may also help identify adenomyosis. Using saline contrast can increase the diagnostic power of a vaginal sonogram to identify a uterine polyp or submucosal fibroid.”
Both laparoscopies and hysteroscopies are more invasive but also more definitive procedures that can diagnose conditions like endometriosis, polyps, and fibroids, which could then be removed. Dr. Barad adds that even regular blood tests, like complete blood counts, C-reactive protein, and white count, can help flag signs of heavy menstural bleeding.
While society has normalized feeling extreme pain during each menstrual cycle, getting to the root cause of conditions like secondary dysmenorrhea may help ease monthly stress and strain.
Vivian Nunez is a writer, content creator, and host of Happy To Be Here podcast. Her award-winning Instagram community has created pathways for speaking on traditionally taboo topics, like mental health and grief. You can find Vivian @vivnunez on Instagram/TikTok and her writing on both Medium and her blog, vivnunez.com.
