By Genester Wilson-King, MD FACOG
Dysmenorrhea, meaning painful menstruation, is an issue that is all too common. Approximately 80% of women experience dysmenorrhea, with 20% facing severe cramping that significantly impacts their daily lives.1 Furthermore, dysmenorrhea is the primary cause of recurrent short-term school absences among adolescent girls and remains a prevalent problem for women of reproductive age.2 However, it’s important to note that not every menstrual cramp qualifies as dysmenorrhea. A more precise definition is painful menstruation severe enough to disrupt daily activities.
In the United States, severe dysmenorrhea leads to a loss of 600 million working hours annually, equivalent to a staggering $2 billion in economic productivity.3 Dysmenorrhea and other menstrual-related symptoms contribute to a great deal of lost productivity. Presenteeism is more of a factor than absenteeism. Absenteeism is the time off work or absence from school. Presenteeism is being present at work or school but not being productive.4
To put it in perspective, women menstruate for three to seven days, from 12 to 51 years of age, resulting in approximately 456 periods over 36 years. This represents an astonishing 6.25 years of life spent in constant pain.5 That’s a truly remarkable fact.
Dysmenorrhea can be classified into two distinct categories: primary and secondary.
- Primary dysmenorrhea usually lacks any underlying identifiable cause and typically occurs during adolescence, generally starting within six to 12 months of the first menstrual period (known as menarche). The pain is usually confined to the menstrual cycle, occurring while the person is bleeding. Its duration can last well into the 20s and sometimes longer.3
- Secondary dysmenorrhea often has an identifiable underlying cause and tends to affect women between 30 and 45 years old. Pain can occur during, before, or after menstruation, and can arise at almost any point during the monthly cycle. Endometriosis is the most common cause of secondary dysmenorrhea, although uterine fibroids and adenomyosis can also be contributing factors.1
Common Treatment for Dysmenorrhea
The most commonly used medications for managing dysmenorrhea are nonsteroidal anti-inflammatory drugs (NSAIDs), which are available over the counter. These drugs have proven to be effective in alleviating dysmenorrheic pain.6,7
Examples of NSAIDs include:
For optimal results, these medications should be taken one to two days before the onset of menstruation and continued as needed during the period.
However, it’s essential to be aware of potential side effects associated with NSAIDs, which can include:
- Stomach ulcers
- Allergic reactions
Taking NSAIDs on an empty stomach causes abdominal pain that can be intense. Indigestion is a relatively common side effect if the medication is taken on an empty stomach or taken too often. Rarely, NSAIDs have been associated with severe adverse events such as heart failure, heart attacks, strokes, kidney, and liver problems. For individuals with severe dysmenorrhea who frequently rely on these medications on a long-term basis, the risk of adverse events (including rare ones) may be higher.8,9
Other treatment options include the use of combined hormonal contraception (commonly known as “birth control pills”) to suppress ovulation. It can be a first-line treatment for many individuals who want relief from dysmenorrhea. Contraception is the second most common defense used.10 This means people in their 20s and 30s can be placed on these synthetic hormones for prolonged periods. However, their use is contraindicated in people with specific medical problems. These include smokers over 35 years old, people with a history of blood clots, certain kinds of hypertension, or those with specific lifestyle behaviors (obesity, elevated cholesterol, uncontrolled hypertension, etc).
Cannabis for Dysmenorrhea
Cannabis has been used for many female conditions for thousands of years. The plant has been used to treat menstrual irregularity, menorrhagia, hyperemesis gravidarum, childbirth, seizures, menopausal symptoms, decreased libido, and dysmenorrhea.11 Many people do not want to take synthetic hormones for various reasons. They may not be suitable candidates for hormonal treatments due to specific medical conditions, lifestyle factors, or personal preferences. In such cases, cannabis may offer a viable alternative.
Cannabis is known for its excellent safety profile and very low risk of adverse effects. CBD-dominant products contain a higher amount of CBD compared to other phytocannabinoids. They have demonstrated effectiveness in managing dysmenorrhea. CBD is known for its pain-relieving, anti-inflammatory, anti-depressant, antispasmodic, and anti-anxiety properties, all of which can address the symptoms associated with primary or secondary dysmenorrhea.12
A holistic approach to addressing dysmenorrhea considers a range of treatment options, including both conventional and alternative methods to prioritize the well-being of the patient. For those interested in exploring cannabis as a treatment option, it is advisable to consult with a cannabis specialist. At Victory Rejuvenation Center, we offer consultations to patients nationwide and can provide management and treatment advice.
- Konar, H. (2016). DC Dutta’s textbook of gynecology. JP Medical Ltd.
- French, L. (2005). Dysmenorrhea. American Family Physician, 71(2), 285-291.
- Dawood, Y, Glob. libr. women’s med., (ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10009
- Schoep, M. E., Adang, E. M., Maas, J. W., De Bie, B., Aarts, J. W., & Nieboer, T. E. (2019). Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women. BMJ open, 9(6), e026186.
- Regional Health-Americas TL. Menstrual health: a neglected public health problem. Lancet Reg Health Am. 2022 Nov 11;15:100399. doi: 10.1016/j.lana.2022.100399. PMID: 36778065; PMCID: PMC9903918.
- Youngster, M., Laufer, M. R., & Divasta, A. D. (2013). Endometriosis for the primary care physician. Current Opinion in Pediatrics, 25, 454-462.
- Dovey, S., & Sanfilippo, J. (2010). Endometriosis and the adolescent. Clinical Obstetrics and Gynecology, 53, 420-428.
- da Costa, B. R., Pereira, T. V., Saadat, P., Rudnicki, M., Iskander, S. M., Bodmer, N. S., … & Jüni, P. (2021). Effectiveness and safety of non-steroidal anti-inflammatory drugs and opioid treatment for knee and hip osteoarthritis: network meta-analysis. BMJ, 375.
- Minhas, D., Nidhaan, A., & Husni, M. E. (2023). Recommendations for the Use of Nonsteroidal Anti-inflammatory Drugs and Cardiovascular Disease Risk: Decades Later, Any New Lessons Learned?. Rheumatic Disease Clinics, 49(1), 179-191.
- Sachedina, A., & Todd, N. (2020). Dysmenorrhea, endometriosis, and chronic pelvic pain in adolescents. Journal of Clinical Research in Pediatric Endocrinology, 12(Suppl 1), 7-17.
- Russo, E. (2002). Cannabis treatments in obstetrics and gynecology: a historical review. Journal of Cannabis Therapeutics, 2(3-4), 5-35.
- Seifalian A, Kenyon J, Khullar V. Dysmenorrhoea: Can Medicinal Cannabis Bring New Hope for a Collective Group of Women Suffering in Pain, Globally? Int J Mol Sci. 2022 Dec 19;23(24):16201. doi: 10.3390/ijms232416201. PMID: 36555842; PMCID: PMC9780805.
- Davis AR, Westhoff CL. Primary dysmenorrhea in adolescent girls and treatment with oral contraceptives. J Pediatr Adolesc Gynecol. 2001;14:3-8.
- Bougie, O., Nwosu, I., & Warshafsky, C. (2022). Revisiting the impact of race/ethnicity in endometriosis. Reproduction and Fertility, 3(2), R34-R41.