Painful Periods (Dysmenorrhea) and Your Fertility

Dysmenorrhea is the clinical term used to describe the cramping pain and discomfort associated with monthly menstruation. In some cases, certain diseases of the reproductive organs are responsible for this condition.

What is Secondary Dysmenorrhea?

Period pain is a common fact of life. Most women experience some type of discomfort during their periods. Termed primary dysmenorrhea, common menstrual cramps can be mildly annoying to moderately painful without eliciting any concern. When menstrual pain becomes severe or debilitating, however, your body may be trying to tell you something. Severe pain may represent secondary dysmenorrhea, underlying medical problems within the pelvis, uterus, ovaries or Fallopian tubes that may require medical attention.

For women who want to conceive a baby, painful periods may be doubly alarming. Although pain itself does not cause infertility, if another reproductive issue is causing it, it may represent barriers to a successful pregnancy.

Overview of the Menstrual Cycle

A typical menstrual cycle takes about 28 days to complete. Throughout the month, the specialized tissue lining the uterus, called the endometrium, slowly thickens in preparation to support a fertilized egg. At the same time, female hormones cultivate the formation of a single-celled egg, which will erupt from the surface of the ovary about two weeks into the cycle. When timed correctly, sperm will contact the egg within one of the Fallopian tubes, which then sweeps the fertilized egg into the uterus to implant and grow in the endometrium.

If conception does not occur, the endometrium sloughs off, and the muscular contractions of the uterus expel the unused lining, resulting in your period. Hormone levels are reset, and the whole cycle repeats itself.

Mild pain typically occurs at two points in a normal cycle: when you ovulate, a sharp little jab called “mittelschmerz,” and when you menstruate and experience cramping. These are very normal and no cause for concern.

Common Medical Conditions That Cause Secondary Dysmenorrhea

Certain disorders of the reproductive anatomy are signaled by persistent, severe menstrual pain:

• Endometriosis—Occasionally, that specialized lining within the uterus grows outside of its normal boundaries and into nearby tissues, such as the ovaries or even nearby intestines. This causes those invaded areas to become inflamed during your period as well, resulting in debilitating pain. This is a fairly common condition in women, and although many can still conceive naturally, about a third experience infertility due to the excess growth’s interference with egg release and implantation.
• Adenomyosis—This is similar to endometriosis, but in this case, the invasive tissue stays within the uterine muscular space. It typically does not cause infertility, but it can definitely generate some painful cramping and heavy bleeding during your period.
• PCOS—Polycystic ovarian syndrome occurs when the egg-releasing follicles on the surface of the ovaries grow but fail to rupture, resulting in a serious imbalance of estrogen and progesterone. PCOS can disrupt and prolong normal menstrual cycles, resulting in a much thicker endometrium and excessive bleeding when the lining finally gives in. Women with PCOS may have significantly fewer normal cycles in a year, decreasing the likelihood of conception.
• Fibroid Tumors—Fibroids are a class of non-cancerous tumors that grow in and around a woman’s uterus. Although they are sometimes asymptomatic, fibroid tumors can cause some significant health problems, including abdominal pain, bowel or urinary changes, and, not surprisingly, difficult periods. While fibroids won’t generally stop you from becoming pregnant, they can create some difficulties as the baby grows, such as placental displacement. Fibroid masses generally need to be removed surgically.
• Normal Aging— Even though we are living youthful, healthy lives much longer these days, our reproductive organs are fickle when it comes to the question of aging. Between the ages of 30 and 40, most women begin to experience perimenopausal changes in their cycle. Dysmenorrhea, unfortunately, is one of the most common. As hormone levels change, periods often become more or less frequent, as well as heavy and painful. These changes may make conception difficult.

If you are experiencing any of the symptoms of dysmenorrhea, be sure to talk to your primary care doctor or gynecologist right away. While they may simply represent the normal discomforts of period cycles, it’s important to rule out more serious possibilities, especially if you are interested in becoming pregnant.