Severe Lower Abdominal Pain During Menstruation: Causes and Solutions

Lower abdominal pain?

On the first day of menstruation, there is severe pain in the lower abdomen on the right side, and the same pain persists on the second day, along with a decrease in menstrual flow.
By the third day, the amount of blood is very minimal or there is no menstrual flow at all.
This has not occurred in the past.

123, 20~29 year old female. Ask Date: 2016/01/12

Dr. Tian Yiwen reply Obstetrics and Gynecology

If you experience abnormal abdominal pain, please visit the obstetrics and gynecology outpatient clinic for an examination.

Reply Date: 2016/01/12

More Info

Severe lower abdominal pain during menstruation, particularly when accompanied by changes in menstrual flow, can be concerning and warrants careful consideration of potential causes and solutions. The symptoms you describe—intense pain on the first and second days of menstruation, followed by a significant decrease in menstrual flow—may indicate several underlying conditions.

Possible Causes
1. Primary Dysmenorrhea: This is the most common cause of menstrual pain. It is characterized by painful cramps in the lower abdomen that typically occur just before or during menstruation. The pain is caused by the release of prostaglandins, which are chemicals in the body that cause the uterus to contract. In some cases, the pain can be severe and debilitating.

2. Secondary Dysmenorrhea: This type of menstrual pain is caused by an underlying reproductive health issue, such as endometriosis, fibroids, or pelvic inflammatory disease (PID). Endometriosis, for example, occurs when tissue similar to the lining of the uterus grows outside of it, leading to significant pain, especially during menstruation.

3. Hormonal Imbalances: Fluctuations in hormone levels can affect menstrual flow and cause pain. Conditions such as polycystic ovary syndrome (PCOS) can lead to irregular periods and painful menstruation.

4. Ovarian Cysts: These fluid-filled sacs on the ovaries can cause pain during menstruation, especially if they rupture.

5. Uterine Fibroids: Noncancerous growths in the uterus can lead to heavy bleeding and pain during menstruation.

6. Pelvic Inflammatory Disease (PID): An infection of the reproductive organs can cause severe pain and changes in menstrual flow.

7. Stress and Lifestyle Factors: High levels of stress, poor diet, and lack of exercise can also contribute to menstrual pain and irregularities in flow.

Solutions and Management
1. Pain Relief: Over-the-counter pain relievers such as ibuprofen or naproxen can help alleviate menstrual cramps. These medications work by reducing the production of prostaglandins.

2. Heat Therapy: Applying a heating pad to the lower abdomen can provide comfort and reduce pain.

3. Lifestyle Modifications: Regular exercise, a balanced diet, and stress management techniques such as yoga or meditation can help improve overall menstrual health.

4. Hormonal Treatments: Birth control pills or hormonal IUDs can help regulate menstrual cycles and reduce the severity of cramps. These options may be particularly beneficial for those with conditions like endometriosis or fibroids.

5. Consult a Healthcare Provider: If the pain is severe or if there are significant changes in menstrual flow, it is essential to consult a healthcare provider. They may recommend further evaluation, including pelvic exams, ultrasounds, or blood tests, to determine the underlying cause of the symptoms.

6. Alternative Therapies: Some individuals find relief through acupuncture, herbal remedies, or dietary supplements, although these should be discussed with a healthcare provider to ensure safety and efficacy.

Conclusion
Severe lower abdominal pain during menstruation, especially when accompanied by changes in menstrual flow, should not be ignored. While primary dysmenorrhea is common, secondary causes may require medical intervention. It is crucial to monitor your symptoms and seek medical advice if the pain persists or worsens. A healthcare provider can help identify the underlying cause and recommend appropriate treatment options tailored to your specific situation.

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