Painful or absent menstruation: dysmenorrhea and amenorrhea can and – in some cases – have to be treated

Many women suffer painful menstruation. In some women menstruation can be absent or disappear altogether, which generally is not harmful but can cause complications if not addressed.

The medical term for painful menstruation is dysmenorrhea. The absence of menstruation is called amenorrhea. While the conditions share a similar name and can cause similar symptoms, their nature and impact on the patient’s body is different. However, abnormal periods with irregular timing can lead to excessive pain as well, aside from further complications such as heavy bleeding long-lasting periods.



Dysmenorrhea refers to painful periods or menstrual cramps that usually occur around the time menstruation begins. Dysmenorrhea is a crampy uterine pain with menstruation that usually occurs in the pelvis or lower abdomen. Dysmenorrhea may be associated with headache, nausea, vomiting and back or leg pain which usually lasts for two to three days before or after the start of menstrual flow.

Dysmenorrhea is caused by prostaglandins, those are natural chemicals produced in the lining of the uterus. The hormone-like chemicals cause the muscles and blood vessels of the uterus to contract.


Most women suffer from menstrual pain

Primary dysmenorrhea occurs without any pelvic pathology, with an estimated prevalence of 25 to 50 percent in adult women and up to 95 percent in adolescents. Dysmenorrhea usually starts after menarche once ovulatory cycles are established. The condition often improves over time and after childbirth.

Secondary dysmenorrhea, on the other hand, is the result of pelvic pathology and often starts after age 20, although it may occur earlier. It usually represents a change from usual patterns of menstrual pain and may be accompanied by menorrhagia, which is the medical term for menstrual bleeding lasting for longer than seven days, dyspareunia (painful intercourse) or chronic pelvic pain.


Treatment of dysmenorrhea

Dysmenorrhea treatment options include non-steroidal anti-inflammatory drugs and hormonal treatments, with the latter also being the first-line treatment if dysmenorrhea is caused by endometriosis.

Rest, mild exercise and the avoidance of stress might also improve the condition. Some women ease the pain by putting a heating pad on the belly or lower back. Taking a hot bath might furthermore help to alleviate the painful cramps.



Amenorrhea is the absence of menstruation in a woman of reproductive age. Although the condition is rare - affecting less than 0.1 percent of women in the United States - amenorrhea should not be ignored. If amenorrhea lasts a long time, problems similar to those associated with menopause may develop. They include hot flashes, vaginal dryness and an increased risk of heart and blood vessel disorders. Amenorrhea can also lead to serious health problems, such as endometrial cancer and osteoporosis.


Can any woman suffer from amenorrhea?

Amenorrhea can occur in women in any age group. The condition can be temporary, irregular or permanent, caused by a dysfunction of the hypothalamus, adrenal gland, ovaries, uterus or vagina.

There are two different types of the condition: primary and secondary amenorrhea. Primary amenorrhea is the absence of menstruation in a woman who has not had a period until the age of 15, which makes the condition primarily a pediatric problem. Most common causes are hormonal imbalances, but anatomical problems can also cause primary amenorrhea.

Secondary amenorrhea, on the other hand, can occur due to natural changes in the body. Secondary amenorrhea is the absence of menstruation for more than three months in women who previously had menstruation. The most common cause of this condition is pregnancy. Breastfeeding and menopause are also common but natural causes.


Treatment of primary and secondary amenorrhea

Birth control pills or other hormone therapies can in some cases restart the menstrual cycle of an affected woman. Amenorrhea caused by thyroid or pituitary gland disorders may be treated with medications. Surgery might be required if a tumor or structural blockage is the cause of the problem.


Can amenorrhea be a symptom of an underlying condition?

There are some specific diseases that can lead to amenorrhea, such as infiltrative lesions or hypothalamic and pituitary tumors. Systemic diseases can also lead to amenorrhea, such as diabetes mellitus, celiac disease, thyroid and hyperandrogenic conditions as well as primary ovarian failure. Other precipitating causes include some diseases with chromosomal abnormalities, such as Turner syndrome, fragile X premutation and autoimmune ovarian destruction.


When is medical help advised for the treatment of amenorrhea?

When a young woman reaches the age of 15 years without having a period, or when a woman's period is absent or delayed for at least 2-3 months, in these cases she should see the doctor. However, in many cases of sexually active women, the simplest answer is also the correct one: One of the most common causes of secondary amenorrhea is pregnancy.


Treatment by Bumrungrad specialist expertise

Amenorrhea patients must be evaluated by a complete history and a detailed physical examination, as well as other tests. Bumrungrad specialists will help find the cause of amenorrhea to prescribe the right treatment to manage the condition. Bumrungrad's specialist expertise is based on extensive experience and a multidisciplinary approach that will help identify any potential underlying condition that could be causing amenorrhea.              

Bumrungrad health center offers complete imaging equipment of the latest technology for safe, fast and reliable diagnosis. Additional sophisticated hormonal blood tests and chromosomal testing are provided to diagnose cases with complicated endocrine abnormalities.


Can amenorrhea be treated naturally?

In certain cases, natural ways such as lifestyle and dietary changes can help treat amenorrhea. This is especially true when the cause of secondary amenorrhea is due to hormonal changes. These changes may be due to weight changes or stressful conditions.

For such patients, lifestyle modifications may be advised, such as managing weight loss or, in patients with low body weight, weight gain. A healthy low-carb and regular exercise may be recommended. In some cases, a normal body weight and general physical well-being help restore normal ovulation and menstrual patterns.


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Bumrungrad International Hospital (BIH) Building, 2nd floor, North Wing of Main Building


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