Dysmenorrhea: Pain Management and Medication Insights

Dysmenorrhea issues and medication consultation?

Hello, doctor.
I am a 22-year-old female who experiences severe menstrual pain every month, and I have also been experiencing ovulation pain in recent months.
I have a history of ovarian cysts from 2014, which have been surgically removed.
I am concerned that my menstrual pain may be due to endometriosis, but I am scheduled for a laparoscopy in about three weeks.
The doctor mentioned that there is no issue with cyst recurrence and also stated that there is no indication of endometriosis.
I would like to know if having undergone a laparoscopy with no abnormalities found in the uterus means that there are no issues.
However, I still experience severe menstrual pain, and I am curious about the possible reasons for this.
Since my dysmenorrhea is quite severe every month, I regularly take pain relief medication.
The pain reliever I take is a non-steroidal anti-inflammatory drug (NSAID), with each tablet containing 150 mg of ibuprofen, which is said to work by inhibiting prostaglandins to achieve pain relief.
I would like to know if this could affect ovulation.
Would it be more appropriate to use acetaminophen for menstrual pain instead?

Miss Li, 20~29 year old female. Ask Date: 2017/04/21

Dr. Huang Jianzhong reply Obstetrics and Gynecology

@ Primary dysmenorrhea occurs when women begin to experience regular menstruation, with pain typically manifesting one to two days before menstruation.
The pain is characterized by cramping and colicky sensations.
Most dysmenorrhea resolves spontaneously by the second to third day of menstruation, and many women find that pain diminishes or disappears with age or after childbirth.
Pain usually starts a few hours before menstruation or shortly after it begins, lasting for 1 to 3 days, often presenting as spasmodic pain in the suprapubic area, sometimes accompanied by lower back pain.
The pain may radiate to the thighs, and symptoms such as nausea, vomiting, and diarrhea are common.
In severe cases, patients may even faint.
Pressing on the abdomen, massaging the area, or changing positions can alleviate the symptoms, which is different from abdominal pain caused by chemical irritation or infection.
@ Secondary dysmenorrhea occurs after a period of time without menstrual pain or when previously mild menstrual discomfort evolves into significant abdominal pain.
The pain can vary in nature, sometimes presenting as cramping or colicky, and at other times as dull, bloating, or even sharp pain.
The nature of the pain does not necessarily lessen with age; instead, it may worsen.
Pain typically begins 1 to 2 weeks before menstruation and can persist for several days after bleeding stops.
There are many potential causes, with endometriosis being the most common, followed by adenomyosis or pain caused by an intrauterine device, among others.
1.
I am a 22-year-old female who experiences severe dysmenorrhea every month and had a history of ovarian cysts in 2014, which have since been removed.
I am concerned that my dysmenorrhea may be due to endometriosis.
Ans: "Having a history of ovarian cysts that have been removed does not rule out endometriosis." This must be clarified with a physician, and a pathological examination may provide insight.
2.
I underwent a laparoscopic examination about three weeks ago, and the doctor stated there was no recurrence of cysts.
When I inquired about the possibility of endometriosis, the doctor also said there was none.
If the laparoscopic examination showed no abnormalities in the uterus, does that mean there are no issues? However, the cause of my dysmenorrhea remains unclear.
Ans: It is still necessary to clarify the aforementioned issues.
3.
I have been experiencing ovulation pain in recent months.
Will this affect ovulation? Ans: No.
4.
Because my dysmenorrhea is severe every month, I regularly take pain medication during this time.
The pain medication I take is a non-steroidal anti-inflammatory drug (NSAID), containing 150mg of ibuprofen per tablet, which is said to relieve pain by inhibiting prostaglandins.
Would using acetaminophen be more appropriate for dysmenorrhea? Ans: Biologically, NSAIDs are generally more effective, but if you find acetaminophen works better for you, why not?

Reply Date: 2017/04/21

More Info

Dysmenorrhea, commonly known as menstrual pain, is a prevalent condition affecting many women, particularly during their reproductive years. It can manifest as severe cramping in the lower abdomen, often accompanied by other symptoms such as nausea, headaches, and fatigue. Given your history of ovarian cysts and the recent laparoscopic examination that ruled out any abnormalities, it is understandable to seek clarity on the ongoing pain you experience.

Firstly, it is essential to recognize that while the absence of cysts or endometriosis during your examination may suggest that these conditions are not the cause of your dysmenorrhea, it does not entirely eliminate the possibility of other underlying issues. Conditions such as primary dysmenorrhea, which is related to the normal physiological processes of menstruation, can still cause significant pain. This type of dysmenorrhea is often linked to the release of prostaglandins, which are hormone-like substances that promote uterine contractions. High levels of prostaglandins can lead to more intense cramps and discomfort.

Regarding your use of non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, they are indeed effective in managing menstrual pain by inhibiting the production of prostaglandins. The typical dosage of ibuprofen for pain relief is around 400-600 mg every 6-8 hours as needed, but it is crucial to follow your healthcare provider's recommendations. While ibuprofen can help alleviate pain, there is a common concern about its potential impact on ovulation. Generally, NSAIDs do not significantly affect ovulation; however, excessive use may lead to gastrointestinal issues or other side effects.
If you are considering using acetaminophen (Tylenol) instead of ibuprofen, it is worth noting that while acetaminophen can also relieve pain, it does not have the same anti-inflammatory properties as NSAIDs. Therefore, it may not be as effective for menstrual cramps specifically caused by high prostaglandin levels. However, if you experience gastrointestinal discomfort or other side effects from ibuprofen, acetaminophen could be a suitable alternative for pain management.

In addition to medication, there are several non-pharmacological approaches that may help alleviate dysmenorrhea. These include:
1. Heat Therapy: Applying a heating pad or hot water bottle to the lower abdomen can help relax the muscles and reduce cramping.

2. Exercise: Regular physical activity can improve overall circulation and reduce the severity of menstrual cramps.

3. Dietary Adjustments: Maintaining a balanced diet rich in omega-3 fatty acids, fruits, and vegetables may help reduce inflammation and pain.

4. Stress Management: Techniques such as yoga, meditation, or deep-breathing exercises can help manage stress, which may exacerbate pain.

5. Supplements: Some women find relief with supplements such as magnesium, vitamin B1, or omega-3 fatty acids, but it's essential to consult with a healthcare provider before starting any new supplements.

If your dysmenorrhea continues to be severe despite these interventions, it may be beneficial to discuss further options with your healthcare provider. They may consider hormonal treatments, such as birth control pills, which can help regulate your menstrual cycle and reduce the severity of cramps.

In conclusion, while your recent examination has ruled out certain conditions, it is essential to continue monitoring your symptoms and exploring various pain management strategies. Open communication with your healthcare provider will be key in finding an effective approach to managing your dysmenorrhea and improving your quality of life.

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