How To Tell If Your Period Pain Is Something More Serious, According To A Gynecologist

Period pain is not uncommon during one's menstrual cycle. However, the intensity of period pain can vary from mild to severe. In an exclusive interview with Health Digest, Rebecca Gonzalez, MD, OBGYN specializing in treating chronic pelvic pain and endometriosis, shared when period pain may be a sign of a larger health issue.

"Mild to moderate discomfort that can be managed with conservative measures such as NSAIDs, exercise, hot or cold packs, etc would be considered normal," Dr. Gonzalez explains. However, there are cases in which period pain may exceed the norm. "Period pain that significantly interferes with quality of life should not be ignored," Dr. Gonzalez states. "Pain that is severe, debilitating, keeps someone home from work or school, limits daily activities, or is associated with other symptoms such as nausea, vomiting, painful urination, painful bowel movements, can all be a sign that there is underlying pathology and not just your standard 'PMS.'"

Additionally, period pain that is accompanied by constant pelvic pressure, pain during intercourse, significant weight changes, ongoing fatigue, severe mood changes, prolonged bleeding, as well as heavy abdominal bleeding are also considered outside the range of normal symptoms, Dr. Gonzalez explains.

"Depending on [the] underlying etiology of painful menses, the potential complications that can arise from delayed diagnosis can vary across a wide spectrum," she states. "Simply put, a delayed diagnosis can lead to disease progression. For example, if pain is related to endometriosis, implants can spread and grow and cause more inflammation and scarring throughout the abdomen and pelvis." Dr. Gonzalez explains that this can lead to more significant health issues down the line. "This can lead to distortion of normal anatomy, infertility, and more difficult and dangerous surgical resection later," she says.

Dr. Gonzalez goes on to tell Health Digest how fibroids can also develop. While usually non-cancerous, fibroids are tumors that form within the uterus. "Fibroids can grow and start to press on other organs and can also lead to large amounts of blood loss which can lead to life threatening anemia and need for blood transfusions," she states. "[S]urgical cure for fibroids also becomes more challenging with increase risks of injury to surrounding structures as they grow larger."

"In rare cases, abnormally heavy or painful periods can be a sign of a more serious condition such as pelvic infections or gynecologic malignancies," Dr. Gonzalez states. "Additionally, we know that untreated pain leads to hypersensitization of pain receptors and chronic pain syndromes. When this occurs it can be very difficult for patients to regain their quality of life even after treatment is initiated for underlying pathology."

However, Dr. Gonzalez points out that there are certain medications that can aid in symptom relief for patients. "Pain medications can help," she says. "The most effective pain medications would ideally be targeted based on the suspected etiology of dysmenorrhea." She states that such medications can include NSAIDs. "NSAIDs play a big role in treatment of dysmenorrhea because a large portion of menstrual pain can be attributed to increased prostaglandin release and up-regulation of other inflammatory markers, and common NSAIDs reduce the production of these."

"Hormonal birth controls as well as a variety of other hormone modulating agents can reduce symptoms significantly in many cases," Dr. Gonzalez adds. "Depending on the etiology of pain, other types of medications may be helpful as well such as muscle relaxers, neuropathic pain medications, anxiolytic and anti-depressants medications can play a role as well."

Dr. Gonzalez goes on to explain that patient treatment plans can look different from one to the next depending on certain factors. "Treatment options will vary depending on etiology of painful menses," she says. "However, regardless of etiology of pain, there is a wide variety of treatment options, ranging from very conservative to invasive approaches."

For some people, certain therapies or lifestyle changes may be helpful. "Physical therapy, massage therapy, exercise, dietary changes, acupuncture, biofeedback, are all conservative approaches that have shown significant benefit in managing dysmenorrhea and premenstrual syndromes even when pathology such as endometriosis is present," she states.

Additionally, as previously mentioned, Dr. Gonzalez reminds us that medication options are also available. However, in some cases, surgery may be the best treatment option for a patient. "And finally, for many causes of dysmenorrhea, surgical intervention may be warranted and in some cases can achieve definitive surgical cure," Dr. Gonzalez states.

In closing, Dr. Gonzalez emphasizes that not only should severe menstrual pain not be ignored, but that individuals should not have to live with the pain in the first place. "It is a common misconception even amongst some of the healthcare community that menstrual cycles are supposed to be painful," she says. "Many patients suffer with severe menstrual abnormalities and are not aware there are options for them to improve their quality of life and overall health."

By normalizing the subject, Dr. Gonzalez points out how a greater number of patients will likely feel more comfortable coming forward in order to seek treatment. "Raising awareness to this topic is essential so that patients do not suffer in silence for years allowing their quality of life to decline year by year and potentially leading to dangerous disease progression in some cases," she states. "Women should be encouraged to have a very low threshold for seeking the evaluation of a trusted women's health provider if they are experiencing undesirable symptoms associated with their menstrual cycle."