Dysmenorrhea, or severe menstrual cramps, is a common and debilitating issue for many women. Fertility Awareness Methods (FAM) can help women and their doctors get to the root cause of their painful periods, whether they are due to primary dysmenorrhea or secondary dysmenorrhea.
Dysmenorrhea: Painful periods
It is estimated that 45-93% of women experience some form of menstrual cramps, with 3-33% of women having cramps so severe that they cause absence from school or work for 1-3 days each cycle. Many women suffer silently with the intense pain of dysmenorrhea, and the condition is underdiagnosed and undertreated. Despite limited data of effectiveness, hormonal contraceptives are often recommended for treatment of dysmenorrhea. Perhaps this is because hormonal contraceptives also serve the function of pregnancy prevention, which many medical organizations prioritize as a top issue in women’s health, especially for young women of reproductive age.
Unlike hormonal contraceptives, however, Fertility Awareness Methods provide insight into the root cause of symptoms, for which restorative reproductive medical care can provide real solutions. FAM users are better equipped to identify and seek treatment for menstrual and reproductive disorders, including dysmenorrhea, because they’ve been educated to understand what is normal and abnormal when it comes to their reproductive health.
How fertility awareness helps with painful periods
Fertility awareness methods are helpful in identifying dysmenorrhea and providing insight into the root cause behind painful periods. Because FAM equips a user to monitor and record her body’s unique biomarkers of fertility and other symptoms throughout her cycle, a woman is given an active role in her care and a shared vocabulary and understanding with her medical provider.
Menstrual irregularities can hint at the underlying cause for symptoms, including menstrual pain. Measurable signs such as a woman’s bleeding pattern, irregular bleeding, brown bleeding, premenstrual spotting, PMS symptoms, heavy flow, unusual discharges, timing and severity of cramps are all relevant indicators of her fertile health. Doctors trained in restorative reproductive medicine use this informationas a vital sign to tailor a woman’s healthcare plan, and confirm or rule out diagnoses.
In some cases, addressing premenstrual syndrome (PMS) can also aid in alleviating menstrual cramps since they often coexist and are interrelated. Lifestyle changes such as diet and exercise can assuage PMS and menstrual pain, and their effects can be visualized through a woman’s fertility chart.
Distinguishing between primary and secondary dysmenorrhea
There are two types of dysmenorrhea: primary and secondary. Knowing which one you have is key to getting the right treatment for your dysmenorrhea. Charting your cycles with a FAM may help you and your doctor determine which one you have, and which treatment is best.
Primary dysmenorrhea is a painful period cramping that isn’t due to an underlying disorder like endometriosis. Primary dysmenorrhea usually develops within 6-24 months of menarche, which is the term for an adolescent’s first menstrual period. Pain from primary dysmenorrhea is recurrent, and occurs just before, or at the start of menstrual flow, and lasts 8-72 hours with peak severity on the first or second day of menstrual flow. Frequently, systemic symptoms such as nausea, vomiting, diarrhea, fatigue, and insomnia accompany the pain.
The effect of these symptoms can have negative impacts on young women’s personal lives and their quality of life. Primary dysmenorrhea symptoms are debilitating enough to be the main cause of recurrent school or work absenteeism in young women.
The underlying cause of primary dysmenorrhea is believed to be overproduction of uterine prostaglandins, and a common treatment is Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), both over-the-counter (OTC) and prescription, for pain relief. Hormonal contraceptives are often prescribed as well . However, the side effects of these treatments can be troubling, and they don’t address the root cause; instead birth control interrupts the normal menstrual and ovulatory cycles, and can allow underlying issues to go unresolved.
In contrast, when bioidentical hormonal therapy is used in restorative reproductive medicine, it is done in concert with the cycle to correct an imbalance. For instance, bioidentical progesterone can be administered in the postovulatory/luteal/post-peak phase of a woman’s cycle, as opposed to birth control, which delivers synthetic hormones to override the entire cycle.
Secondary dysmenorrhea is due to an underlying pelvic pathology. The most common cause of secondary dysmenorrhea is endometriosis, but it may also arise from other issues such as Pelvic Inflammatory Disease (PID) or uterine fibroids.
Endometriosis is a condition where tissue similar to that which lines the uterus (the endometrium) grows outside the uterus. Although pelvic exams, ultrasound, and MRI can be helpful for identification of endometriosis, the gold standard is a diagnostic laparoscopy. In this surgical procedure, small incisions are made in the abdominal area, for the surgeon to insert a scope and instruments. Through the laparoscope the surgeon will visualize and confirm whether endometrial lesions are present. If possible, laser excision treatment may also proceed at that time. If the disease is found to be deep and/or widespread, it may require more extensive surgical management via laparotomy.
A surgeon trained in NaProTechnology  (a field of restorative reproductive medicine) will work to thoroughly remove endometriosis tissue to revive normal function, reduce pain, and restore fertility. Other surgeons may or may not be as experienced or meticulous with these techniques, since the current guidelines suggest moving to assisted reproductive technologies (ART) as a means of addressing endometriosis-related infertility. As with primary dysmenorrhea, another mainstay of secondary dysmenorrhea treatment is hormonal birth control. However, this approach doesn’t actually treat the endometrial adhesions and carries significant side effects.
For women suffering with dysmenorrhea, FAMs and the associated reproductive medicine provides great hope. Going beyond the pill and utilizing therapies that are tailored to the individual woman’s cycle provides women with real solutions. This is one of the many reasons that charting with a FAM in adolescence can be useful beyond knowledge and understanding of one’s body and health. It’s not merely an academic exercise but has bearing on daily life, both physically and emotionally. Tracking the menstrual cycle is a key component to addressing, understanding, and treating dysmenorrhea.
- Bernardi M, Lazzeri L, Perelli F, Reis FM, Petraglia F. Dysmenorrhea and related disorders. F1000Res. 2017;6:1645. Published 2017 Sep 5. doi:10.12688/f1000research.11682.1
- Burnett M, Lemyre M. No. 345-Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2017;39(7):585‐595. doi:10.1016/j.jogc.2016.12.023
- Osayande AS, Mehulic S. Diagnosis and initial management of dysmenorrhea. Am Fam Physician. 2014;89(5):341‐346.
- Balık G, Ustüner I, Kağıtcı M, Sahin FK. Is there a relationship between mood disorders and dysmenorrhea?. J Pediatr Adolesc Gynecol. 2014;27(6):371‐374. doi:10.1016/j.jpag.2014.01.108
- Bahrami A, Avan A, Sadeghnia HR, et al. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol Endocrinol. 2018;34(8):659‐663. doi:10.1080/09513590.2017.1423466
- Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update. 2015;21(6):762‐778. doi:10.1093/humupd/dmv039
- Osayande, A. and Mehulic, S. Diagnosis and Initial Management of Dysmenorrhea. Am Fam Physician. 2014. 1;89(5):341-346. Available at: <https://www.aafp.org/afp/2014/0301/p341.html>
- Rolla E. Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment. F1000Res. 2019;8:F1000 Faculty Rev-529. Published 2019 Apr 23. doi:10.12688/f1000research.14817.1