Menstrual pain, or in its medical name, dysmenorrhea, is common. We have come to see it as a fact of life, but how much do we know about its impact on the lives of adult and adolescent who menstruate? How does the pain affect academic performance, concentration, school attendance, and how can early diagnosis and treatment help narrow societal gaps?
Dysmenorrhea, the medical term for pain around menstruation, is likely the most common symptom related to monthly bleeding. It is usually described as a sharp pain in the lower abdomen or back, before or during the bleeding itself. At times it is accompanied by other symptoms such as nausea, diarrhea, headaches, fatigue, dizziness, or sleep disturbances.
While pain during monthly bleeding is quite common, its strength and character are not uniform. While some experience relatively light cramps, for others the pain is debilitating. Only a small percentage of menstruating adolescent and adults seek medical care for the pain, making it difficult to assess its prevalence, but researchers estimate that 60-93% of adolescents report pain, and of those, 15% seek medical care. In anonymous surveys, adolescents reported the negative impact of the pain on academic performance, concentration and learning, and test results. 14% of the adolescents reported that they miss school days because of pain attacks, and in most cases those adolescents are unaware of the reason for the pain, or potential treatments. In fact, dysmenorrhea is the most common reason why adolescent females miss school. While males of the same age enjoy sports and social activities all month, females who suffer from sharp pain struggle to function normally for several days each month. For those females, absence from school affects learning continuity, academic achievement, and social integration.
Dysmenorrhea that appears during adolescence is usually primary dysmenorrhea, meaning that it is not associated with pelvic pathology or a disorder in the reproductive system. It could also be secondary dysmenorrhea, often caused by endometriosis. Other causes for secondary dysmenorrhea could be ovarian cysts, adenomyosis, and an intrauterine device (IUD) during the first six months of use. When pain affects daily functioning, in the presence of systemic symptoms (headache, fatigue, vomiting, and diarrhea), or pain that is unaffected by medication, it is recommended to rule out secondary dysmenorrhea by undergoing a physical examination and a pelvic ultrasound.
Diagnosing illness related to pelvic pain can take a long time. To reduce diagnostic delay, healthcare providers should be aware of the psychosocial impact cultural attitudes toward menstruation, the patient’s comfort level in discussing the topic, parental and family dynamics surrounding the expression of pain, and the anxiety that often accompanies the pain. Research on the level of knowledge about effective treatment among adolescents found a lack of awareness and misinformation: just 54% of adolescents thought that “certain medications can ease the pain,” and few could name the relevant medications. These findings highlight the importance of making information on the treatment of menstrual pain more accessible as part of routine gynecological examinations during adolescence.
Early identification and diagnosis lead to effective treatment and could mitigate the negative effects of menstrual pain on one’s life. Because the main treatment objective is to ease symptoms, the first-line option for treating dysmenorrhea is a non-steroidal anti-inflammatory drug (NSAID). Medical providers in the United States tend to recommend aspirin, while in Israel ibuprofen is most frequently recommended alongside simple pain relievers such as paracetamol. Use of pain relievers immediately with the onset of symptoms is more effective than consuming those medications later, and in difficult cases they can be taken even one to two days before menstruation.
In cases where pain medication was ineffective, the second treatment option is the oral contraceptive pill. The pill can also serve as a first-line treatment in sexually active adolescents who suffer from dysmenorrhea, easing pain and preventing pregnancy simultaneously. The pill disrupts natural hormonal fluctuation, prevents ovulation, and therefore lowers prostaglandin levels—the lipid compounds that cause cramping in the uterus and menstrual pain. As with any medication, oral contraceptives have side effects. Each patient should be openly consulted with, the benefits and drawbacks of the pill in treating dysmenorrhea weighed, and a decision reached that is personally fitting to that patient.
Undiagnosed and untreated dysmenorrhea, then, can impact the daily functioning of adolescent females. But more than that, it has long-term effects on the status of women in society, the workforce, and academia. By tracking biological and psychosocial symptoms, dysmenorrhea can be diagnosed and treated, contributing to adolescent health, and reducing sex and gender-based social disparities.
Lia Novick is a medical student in the Faculty of Medicine in the Galilee, Bar-Ilan University