Painful or irregular periods? It could be an underlying condition

Find out more about how uterine fibroids, endometriosis and other conditions may contribute to symptoms of painful or irregular periods.

Painful or irregular periods can be uncomfortable and inconvenient, and sometimes, can significantly disrupt your life. Menstrual pain, also known as dysmenorrhea, is a common issue experienced during the menstrual cycle. This type of pain can range from mild to severe and is often accompanied by other symptoms, such as nausea, fatigue or headaches. In some cases, painful periods can be caused by conditions like endometriosis or uterine fibroids.

Irregular periods are characterized by variations in the length of the menstrual cycle or the amount of bleeding. There are multiple conditions that can contribute to irregularities in the menstrual cycle.

Abnormal bleeding

  • An abnormal period may involve:
  • Irregular bleeding
  • Heavy menstrual bleeding
  • Severe period pain
  • Pelvic pain
  • Menstrual irregularity
  • Abnormal uterine bleeding

“There are multiple causes of abnormal uterine bleeding. Some of the ones we see most often include fibroids, adenomyosis, endometrial polyps, clotting disorders and hormonal issues. Rarely, abnormal bleeding can be a sign of a more serious health condition, so it’s important to talk to your doctor and get it checked. Pinpointing the exact cause is usually possible after an exam in the office, an ultrasound and lab work” said Steven J. Radtke, M.D., FACOG, FMIGS, minimally invasive gynecologic surgeon at Norton Urogynecology Center, part of Norton Women’s Care.

Symptoms of abnormal bleeding may include:

  • Bleeding between periods
  • Bleeding after sex
  • Irregular, unpredictable periods
  • Menstrual flow that is much heavier than usual
  • Bleeding after menopause
  • Bleeding that is accompanied by severe pain or cramping
  • Bleeding that lasts for more than seven days

New or sudden changes to your menstrual cycle, including amount of flow or more painful cramps, potentially can indicate other health conditions. Worsening pain is another red flag.

It is important to address any concerns regarding painful or irregular periods with your provider to determine the underlying cause and develop an appropriate management plan tailored to your individual needs and health goals, such as family planning.

“Nowadays there’s a wide range of treatment options available, surgical and nonsurgical, that can help address these symptoms and improve a patient’s quality of life — tailored to their particular circumstances and goals. It’s always a good first step to talk to your primary care doctor or OB/GYN about your concerns,” Dr. Radtke said.

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Period pain

Dysmenorrhea, commonly known as period pain, is a condition that affects many people during their menstrual cycle. The primary symptom of dysmenorrhea is cramping in the lower abdomen, which can range from mild to severe, and often can radiate to the lower back and thighs. Other symptoms that are associated with dysmenorrhea may include nausea, vomiting, diarrhea, headaches and fatigue.

Treatment options for dysmenorrhea aim to alleviate pain and discomfort. Over-the-counter pain medications, such as ibuprofen or acetaminophen, often are recommended to help manage cramps and reduce inflammation, in addition to the use of a heating pad. For more severe cases, a health care provider may prescribe birth control or higher-strength nonsteroidal anti-inflammatory drugs for pain relief. Additionally, lifestyle changes such as regular exercise and dietary modifications can help alleviate symptoms of dysmenorrhea.

Primary dysmenorrhea and secondary dysmenorrhea are two distinct conditions that involve painful menstrual periods. Primary dysmenorrhea is typically related to normal menstrual processes, while secondary dysmenorrhea is caused by an underlying medical condition and requires specific treatment to address the root cause of the pain.

Primary dysmenorrhea refers to common menstrual cramps that occur in the absence of any underlying gynecological issues. These cramps typically are caused by the contractions of the uterus as it sheds its lining during menstruation. The pain usually is felt in the lower abdomen and can be managed with over-the-counter pain medication and lifestyle changes.

Secondary dysmenorrhea involves period pain that is a symptom of an underlying medical condition, such as endometriosis, fibroids or pelvic inflammatory disease. The pain with secondary dysmenorrhea is often more severe and may worsen over time. Treatment for secondary dysmenorrhea targets the underlying cause and may involve medications or surgery.

If you are experiencing dysmenorrhea, especially severe or new pain, you should consult with your health care provider.

Uterine fibroids and endometriosis

Uterine fibroids and endometriosis are two common gynecological concerns. Period pain from uterine fibroids or endometriosis is considered secondary dysmenorrhea. Both conditions also may cause painful periods and chronic pelvic pain.

Fibroids are noncancerous growths or tumors that develop in the uterus, often causing symptoms like heavy menstrual bleeding and pelvic pain. Endometriosis is a condition where tissue similar to the inside lining of the uterus starts growing in places where it doesn’t belong, such as the pelvic sidewall, bladder, rectum, etc.  This produces an inflammatory response that worsens during menstrual cycles. Common symptoms include severe pain, bloating, painful vaginal intercourse, painful urination and painful bowel movements. Some patients also may experience infertility.

“A patient is considered to have advanced endometriosis when: No. 1, there is a high burden of disease, for instance, if lesions are covering a large percentage of the pelvis. And No. 2, if endometriosis implants are located on critical structures, such as the bladder, ureters, intestines, diaphragm, etc.,” Dr. Radtke said.

Symptoms of endometriosis often are controlled with hormonal medications such as birth control pills, or medications that temporarily decrease estrogen levels in the body. However, surgery may be recommended in cases where symptoms are severe, are not improving with conservative measures, if advanced disease is suspected, or if a patient does not want to take hormonal medications. Surgery involves removing the tissues affected by endometriosis, allowing the body to regenerate new healthy tissue in its place (excisional surgery).

“Chronic pelvic pain in reproductive-age females is caused by endometriosis 70% of the time, but there can be other issues that cause it as well, such as ovarian cysts, scar tissue, issues with the bladder, intestines or pelvic floor muscles,” Dr. Radtke said. “It is important to talk to your doctor in order to start investigating possible causes.”

Minimally invasive surgical treatments

There are numerous minimally invasive gynecologic surgery (MIGS) options for patients, including those who desire to get pregnant.

“For patients with endometriosis who desire to preserve fertility and want to avoid hormonal medications, the surgical treatment involves making small incisions — less than 1 centimeter — in the abdomen and ‘stripping’ the endometriosis off the affected structures,” Dr. Radtke said. “During this process, scar tissue is also removed in order to restore normal anatomy. We also test the fallopian tubes to make sure they are not blocked.

“When patients are done with childbearing, performing a hysterectomy at the time of endometriosis surgery significantly decreases the chances of it coming back in the future. We usually recommend not removing the ovaries, unless they are very abnormal.”
A MIGS procedure may be considered for some patients with complex conditions.

Patients should speak to their provider about a referral for a MIGS evaluation for the following complex conditions: 

  • Advanced endometriosis (affecting bladder, gastrointestinal tract, diaphragm, etc.)
  • Chronic pelvic pain without apparent cause
  • Frozen pelvis
  • Severe scar tissue
  • Large leiomyomas (fibroids)
  • Large ovarian cysts
  • Conditions that may make surgery more complicated, such as obesity, diabetes, chronic anticoagulation or circulatory issues

Addressing the root cause of painful or irregular periods is crucial for maintaining reproductive health and overall well-being. Consulting with your provider for proper diagnosis and treatment options is essential when it comes to managing your reproductive and overall health.

“If you feel like your life revolves around pelvic pain, or worrying about your next menstrual cycle, we’re here to help you get your life back,” Dr. Radtke said.

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