Dysmenorrhea, pain associated with a menstrual period, is due to the release of prostaglandins, inflammatory chemicals that trigger the uterine contractions that cause the menstrual lining to shed. Most women experience some degree of dysmenorrhea during menstruation, ranging from mild discomfort to severe pain.
Women commonly experience menstrual cramps, which can present as lower abdominal pain, lower back pain, or both. Some women may experience nausea, vomiting, diarrhea, headaches, or hip or thigh pain as well.
Primary dysmenorrhea, the most common type, is due to the menstrual cycle itself, without another underlying cause. Secondary dysmenorrhea is when pain is due to an additional medical cause, such as endometriosis or uterine fibroids.
Menstrual cramping generally comes when a woman is already bleeding and is generally not considered a hargashah. Therefore, it does not affect a woman’s niddah status. Learn more here about what type of sensation can be halachically considered a hargashah.
Dysmenorrhea usually begins within a day or two before menstruation, and ends a day or two after bleeding starts, although secondary dysmenorrhea may start earlier and last longer. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen or naproxen, can help with pain symptoms, when used appropriately. NSAIDs are most effective when they are taken before the pain begins, rather than when the pain has already started.
Heat may also help relieve some symptoms, as can some alternative therapies such as acupuncture, acupressure, or transcutaneous electrical nerve stimulation (TENS). Other types of painkillers may also provide some pain relief.
A woman who is concerned about the severity of her menstrual pain, or whose functioning is impaired due to the severity of the pain, should discuss this with her healthcare provider. Typically, initial treatment is with NSAIDs. If NSAIDs do not provide sufficient pain management, hormonal treatment, usually beginning with common methods of birth control, is often the second-line treatment to manage severe dysmenorrhea.
