Dysmenorrhea is mainly divided into two major categories: primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea has no organic disease, and accounts for the majority. Secondary dysmenorrhea is caused by pelvic disease and requires treatment targeting the underlying cause.
🩺 What Types of Dysmenorrhea Are There? What Are the Causes of Each?
1. Primary Dysmenorrhea
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Features: No clear pelvic organic disease; common in adolescent girls or women who have not given birth. Usually appears within 1–3 years after menarche.
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Presentation: Begins several hours to 1–2 days before menstruation, most severe on the first day, gradually relieves after 2–3 days. Typically cramping lower abdominal pain, which may radiate to the lumbosacral region and medial thigh, and may be accompanied by nausea, diarrhea, fatigue, etc.
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Causes: Mainly related to excessive prostaglandin (PG) secretion by the endometrium during menstruation. Excess prostaglandins cause excessive contraction of the uterine smooth muscle and vascular spasm, resulting in uterine ischemia and hypoxia, which causes pain.
2. Secondary Dysmenorrhea
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Features: Caused by pelvic organic disease; usually appears several years after menarche, and pain often shows a progressively worsening trend.
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Presentation: Pain may begin before menstruation and persist after it ends. Often accompanied by symptoms such as dyspareunia, non-menstrual pelvic pain, painful bowel movements, abnormal bleeding, or infertility.
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Common causes:
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Endometriosis: Endometrial tissue grows outside the uterine cavity; it is the most important cause of secondary dysmenorrhea.
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Adenomyosis: Endometrium grows into the uterine muscle layer, causing expansion of the myometrium and severe dysmenorrhea.
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Others: Uterine fibroids, pelvic infection, cervical adhesions/stenosis, uterine reproductive tract malformations, intrauterine device (IUD), etc.
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🚨 When Should You Seek Medical Attention Promptly?
If any of the following occurs, it is recommended to see a gynecologist promptly:
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The pain is severe and seriously affects life and work
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Dysmenorrhea worsens year by year
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Non-menstrual abdominal pain occurs
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Heavy menstrual flow with clots and irregular bleeding
💊 Medications
Primary Dysmenorrhea (first-line choice)
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Non-steroidal anti-inflammatory drugs (NSAIDs): Such as ibuprofen, ketoprofen, diclofenac, etc. They relieve pain by inhibiting prostaglandin synthesis, reducing uterine tension and contractility. Timing is key — they should be started when pain begins or 1–2 days before menstruation, and continued for 2–3 days. Taking them with food is recommended to reduce gastrointestinal discomfort.
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Chinese patent medicines: Such as Yimucao Granules, Tianqi Dysmenorrhea Capsules, Aifu Nuangong Pills, etc., which should be used under medical guidance based on syndrome differentiation.
Secondary Dysmenorrhea
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Treatment must target the underlying disease. For example, endometriosis may require hormonal drugs such as progestogens or GnRH-a, or consideration of surgery.
🧘 The Best Treatment and Care Methods
1. First Step: Lifestyle and Non-pharmacological Methods (foundation)
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Precise heat application: Use a hot water bottle or heat patch at 40–45°C on the lower abdomen for 15–20 minutes each time. This can promote pelvic blood circulation and relax the uterine smooth muscle.
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Dietary adjustments: In the week before menstruation, reduce intake of high-salt, high-sugar, caffeine, and alcohol. Increase foods rich in omega-3 fatty acids (deep-sea fish, flaxseed) and magnesium (nuts, green leafy vegetables), which help reduce prostaglandin synthesis.
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Regular exercise: Moderate aerobic exercise (brisk walking, yoga) promotes endorphin release, a natural pain reliever. Studies confirm that a balanced diet and regular exercise can reduce the severity of dysmenorrhea.
2. Second Step: Over-the-Counter Medications
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As with the NSAIDs above. If symptoms improve after 2–3 months but pain persists, consider combining other methods; if ineffective, seek medical attention to rule out secondary causes.
3. Third Step: Prescription Medications and Specialist Treatment
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For those with poor response to NSAIDs, doctors may evaluate the use of hormonal drugs (such as oral contraceptives).
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Secondary dysmenorrhea must be treated according to the underlying disease.
🦾 Supports and Exercise Equipment
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Womb-warming patches/hot water bottles: Basic tools for precise heat application; keep the temperature at 40–45°C to avoid burns.
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TENS (transcutaneous electrical nerve stimulation) devices: Some studies suggest TENS may have an adjunctive relieving effect on dysmenorrhea and can be used as one non-pharmacological option.
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Yoga mat: For gentle menstrual stretching and relaxation exercises.
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Exercise equipment: Low-impact aerobic equipment (such as elliptical machines and stationary bikes) is suitable for gentle exercise before and during menstruation, promoting endorphin release.
⚠️ Behaviors That Particularly Need to Be Avoided
1. Blind heat application (the most common misconception)
Heat application is only suitable for cold-coagulation and blood-stasis type dysmenorrhea (manifesting as cold pain in the lower abdomen that relieves with warmth). For damp-heat stagnation type (burning pain in the lower abdomen, thick and odorous menstrual blood, bitter taste in the mouth, yellow urine), heat application will aggravate symptoms, equivalent to “adding fuel to the fire.” If you cannot determine the syndrome type, consult a doctor.
2. Exposure to cold stimulation during menstruation
Avoid getting rained on, washing feet with cold water, or taking cold baths. Cold drinks, ice cream, and other cold foods are not conducive to blood circulation, and spicy foods may stimulate vasodilation and cause heavy menstrual flow. Air conditioning temperature should not be too low or blow directly on the body.
3. Swimming, hot springs, or tub baths during menstruation
At this time, the lower genital tract is in an “open and fragile” state, which increases the risk of infection. During menstruation, keep the vulva clean, but do not perform vaginal douching.
4. Sexual intercourse during menstruation
Vaginal defense function is reduced, bacteria can easily invade, and it may also cause retrograde menstrual flow, increasing the risk of endometriosis.
5. Medication abuse
The causes of dysmenorrhea are diverse, and secondary dysmenorrhea may be related to organic disease. Women with a history of dysmenorrhea should first seek medical attention to clarify the cause before using medication.
6. Surgery during menstruation
The risk of bleeding and infection during menstruation is greatly increased, and immune function is reduced, which is not conducive to wound healing. Unless it is an emergency, surgery should be avoided during menstruation.