Menstrual Pain: Is It Normal to Experience Delayed Discomfort?

Inquiry about menstrual pain-related issues?

Hello, doctor.
I am 24 years old, and I have experienced menstrual cramps since I started my period over 10 years ago.
Typically, I have cramps during the first 1-2 days of my menstrual cycle, and I usually take pain relievers on the first day to ensure I can attend work and classes.
My menstrual cycle is quite regular, occurring approximately every 30 days.
However, in recent cycles, I have started to experience a pattern where I have cramps on the first day, feel fine on the second and third days, but then suddenly experience cramps again on the fourth or fifth day.
Since I have never experienced this symptom before, I would like to know if this is a normal occurrence or if there is anything I should be concerned about.
Thank you for your assistance!

YHL, 20~29 year old female. Ask Date: 2022/02/25

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the estimated 80-90% of women experience symptoms of dysmenorrhea, with varying degrees of severity, which can often impact work or academic performance.
Therefore, accurate diagnosis and treatment can help improve quality of life and work efficiency.
Dysmenorrhea can generally be classified into primary and secondary types.
1.
Primary dysmenorrhea: This is caused by intrinsic mechanisms of the uterus, with no abnormalities in the pelvic structures; pelvic examinations and ultrasounds are normal.
Symptoms often begin 1-2 years after menarche, peaking between the ages of 23 and 27.
Women who experience early menarche, have heavier menstrual flow, have never given birth, are obese, have high socioeconomic status, are single, or are under stress may experience more severe symptoms.
Most women find that symptoms improve with age or after childbirth.
2.
Secondary dysmenorrhea: This arises from pathological changes in the pelvic organs, such as adenomyosis, endometriosis, uterine fibroids, endometrial polyps, pelvic inflammatory disease, or the presence of an intrauterine device (IUD), which may all be contributing factors.
These pathological conditions can also be associated with infertility and dyspareunia, and treatment methods vary depending on the underlying cause.
In addition to avoiding cold foods, using a heating pad, hot water bottle, or heat wrap on the lower abdomen can help alleviate pain, promote blood circulation, and relieve dysmenorrhea.
Besides taking pain relief medication as directed by a physician, it is recommended that if symptoms persist or worsen, you should consult a gynecologist for examination and treatment.
Thank you!

Reply Date: 2022/02/25

More Info

Menstrual pain, also known as dysmenorrhea, is a common experience for many women during their menstrual cycles. It can manifest as cramping, discomfort, and pain in the lower abdomen, and it typically occurs in the first few days of menstruation. However, your recent experience of having pain that re-emerges several days after the initial discomfort is indeed noteworthy and warrants further exploration.

Firstly, it is essential to understand that menstrual pain can vary significantly from cycle to cycle and from person to person. While many women experience primary dysmenorrhea, which is pain caused by the natural process of menstruation, some may also experience secondary dysmenorrhea, which is pain resulting from underlying conditions such as endometriosis, fibroids, or pelvic inflammatory disease. The fact that you have had consistent menstrual pain for over ten years suggests that you may be experiencing primary dysmenorrhea, but the recent change in your pain pattern could indicate a shift that should be evaluated.

The sudden onset of pain on days four or five of your cycle, after a few days of relief, could be attributed to several factors. One possibility is that your uterus may still be contracting as it sheds its lining, which can sometimes lead to discomfort even after the initial days of menstruation. Hormonal fluctuations during your cycle can also play a role; for instance, prostaglandins, which are hormone-like substances involved in pain and inflammation, may still be elevated in your system, leading to delayed pain.

Another consideration is the potential development of an underlying condition. Conditions such as endometriosis can cause pain that is not limited to the menstrual phase and may lead to discomfort at various times during the cycle. If you have not been diagnosed with any such conditions, it may be worth discussing with your healthcare provider, especially since your pain pattern has changed.

In terms of what you should monitor, consider keeping a menstrual diary. Documenting the timing, intensity, and nature of your pain, along with any other symptoms (such as changes in flow, nausea, or other discomforts), can provide valuable information for your healthcare provider. This record can help in identifying patterns or triggers that may be associated with your pain.

If your pain continues to change or worsen, or if you experience additional symptoms such as heavy bleeding, irregular cycles, or pain during intercourse, it would be prudent to seek medical advice. A healthcare provider may recommend a pelvic exam, ultrasound, or other diagnostic tests to rule out any underlying conditions.

In summary, while experiencing menstrual pain is common, the recent change in your pain pattern is something to take note of. It is advisable to monitor your symptoms closely and consult with a healthcare provider if the pain persists or if you have any concerns. They can help determine whether this is a normal variation in your menstrual cycle or if further investigation is needed to rule out any underlying issues. Remember, your health and comfort are paramount, and seeking help is always a wise choice when it comes to changes in your body.

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