Period Pain: Primary vs. Secondary Dysmenorrhea

While some people experience little to no symptoms, for others their monthly cycle puts a huge damper on their life and overall well-being. According to The American College of Obstetrics (ACOG) and Gynecology, more than half of menstruating women experience some pain during their period that lasts for at least one to two days a month. 

The medical term for period pain is dysmenorrhea. There are two types of dysmenorrhea, primary and secondary. Understanding these different types can help you better understand where your pain may be coming from, what you can do about it, and give you more information so that you can advocate for yourself in medical settings.

What is the difference between primary and secondary dysmenorrhea? We’re here to explain. 

Symptoms of Dysmenorrhea

People typically associate cramps with period pain. For those who experience dysmenorrhea, it often doesn’t stop with cramps. Painful periods can also come with a whole slew of other symptoms like:

• Pelvic pain
• Lower back pain
• Cramping or pain in the lower abdomen
• Nausea 
• Vomiting
• Headaches
• Dizziness
• Pain that radiates down the legs
• Fatigue
• Fainting

Experiencing intense pain and uncomfortable symptoms for multiple days a month can also have a severe impact on someone’s mental health. Many people with dysmenorrhea may also experience symptoms of PMS or PMDD, along with anxiety or hopelessness around being in so much pain every month. 

Primary Dysmenorrhea

Cramps that come before or during your period are what’s called primary dysmenorrhea.

They can happen before or during your period and are caused by the hormone-like substance prostaglandins. 

Prostaglandins help with a wide range of bodily functions like blood flow and labor. They also cause the muscles and blood vessels in the uterus to contract during menstruation. This helps to release endometrium (uterine lining) from your uterus, aka your period. 

Prostaglandin levels tend to be higher at the beginning of your period and taper off towards the end. Hence many people experience more pain at the start of their period, which tends to subside after a few days.

Primary dysmenorrhea typically starts within six to twelve months of the start of menarche (an adolescent’s first period), and can often get better with age. 

Secondary Dysmenorrhea

Secondary dysmenorrhea on the other hand is period pain that is caused by a reproductive health disorder, pelvic pathology, or other medical condition. This type of period pain may start a few days before the beginning of a period, can get worse throughout each cycle, and may even continue at the end of each period. 

This type of period pain can be so severe that it interferes with daily activities for several days per month. Endometriosis is the most common cause of secondary dysmenorrhea. 

Secondary dysmenorrhea can also be caused by:

• Fibroids
• Congenital defects in the reproductive organs
• Tumor, infection, or polyps in the pelvic area or reproductive organs
• Adenomyosis
• Polycystic Ovary Syndrome (PCOS)
• Miscarriage, pregnancy loss, or an ectopic pregnancy

While less common, adolescents can have secondary dysmenorrhea. Endometriosis in adolescents can be difficult to diagnose because the lesions may be clear or red and harder to identify than those in an adult. 

Treating Dysmenorrhea

Treatment for dysmenorrhea depends on the root cause of the pain, and if it’s primary or secondary. Your OB-GYN will most likely perform a pelvic exam, followed by blood tests and possibly an ultrasound. 

For cases that need further diagnosing, a laparoscopy may be performed. This is a minimally invasive procedure that involves making a small incision near the belly button to allow a laparoscope, or thin lighted camera, into the abdomen to explore what’s going on inside. 

Primary dysmenorrhea can often be managed through over-the-counter medications like ibuprofen, naproxen, and acetaminophen, as well as using a heating pad when you have pain. Some people may find relief through dietary and lifestyle changes, and by taking certain supplements like magnesium.

Secondary dysmenorrhea is more complex because it can be caused by a wide range of disorders. Depending on the root cause of your pain, you may be advised to take certain medications like hormonal birth control, undergo surgery, or make certain lifestyle changes.

Many people find some relief from any kind of dysmenorrhea by seeing a holistic healthcare provider like an acupuncturist or naturopathic doctor. 

Advocating for Yourself

Period pain may be common, but it’s not necessarily normal. We hope you’re able to find medical providers who are supportive and understanding of your needs, but unfortunately, that’s not always the case. 

Being able to advocate for yourself can help you get more access to testing, scans, and procedures so that you can understand what’s going on in your body. This is especially essential in reproductive health care, an area where women’s bodily autonomy is so often stifled.

If you’re experiencing period pain (or you just want better health care), here are a few tips to better advocate for yourself:

• Track your symptoms, energy levels, and anything else that may be connected to what you’re experiencing.
• Do your research ahead of time. It shouldn’t all be on you, but being prepared helps you know what your options are.
• Come with a list of questions. It’s easy to forget them when you’re being rushed through an appointment, so coming with a list will help you cover all your bases.
• Don’t be afraid to speak up. Medical care is a service that you’re paying for either with your taxes or out of pocket, you deserve to have the best care possible, even if that means asking for a different provider. 

Everyone deserves to feel comfortable and at ease in their body, even during your period. If period pain is seriously (or minorly) impacting your life, we urge you to explore your options.