Are people with dysmenorrhea less likely to get pregnant? Doctors answer: The truth is...

Dysmenorrhea can be said to be a nightmare for many women. In mild cases, it causes back pain, and in severe cases, the woman has to rely on painkillers to "keep her life" or even faints from the pain.

People often associate dysmenorrhea with childbirth. For example, the older generation used to say, "You will no longer have dysmenorrhea after giving birth" (this is a rumor, a rumor, a rumor!!!). Some time ago, there was another hot search saying, "People with dysmenorrhea have a constitution that makes it difficult for them to conceive." Is this true? Will dysmenorrhea affect pregnancy?

Image source: Internet screenshot

This issue needs to be discussed separately.

What is menstruation?

Just as human skin is divided into the epidermis and dermis, the endometrium is also divided into the functional layer and the basal layer.

As the name suggests, the basal layer is like the foundation, located at the bottom layer, constantly producing new cells; the functional layer is like the surface building, containing dense blood vessels and rich glands extending from the basal layer, which are used to perform the functions of the endometrium.

Schematic diagram of the uterus. Image source: created by the author

In every normal menstrual cycle, newly developed follicles and the corpus luteum after ovulation (to learn about the corpus luteum, you can review "A must-read for women! How terrible is "corpus luteum rupture"?") produce estrogen and progesterone to promote the thickening and maturation of the functional layer of the endometrium, making it suitable for early embryo implantation.

If no embryo is produced, the corpus luteum will atrophy at the end of its life, and the endometrium will also atrophy and fall off due to the loss of hormonal support from the corpus luteum, and be discharged from the body mixed with blood and tissue fluid as menstruation.

Image source: Reference [1]

Simply put, menstruation is the result of regular renewal of the functional layer of the endometrium. Since menstruation is closely related to follicular development, ovulation and other behaviors, regular menstruation can be considered a sign of normal ovulation.

Dysmenorrhea and dysmenorrhea are not the same

Dysmenorrhea is not a single disease, and the causes of dysmenorrhea in different people may be completely different.

Dysmenorrhea without any structural abnormalities or pathological changes is called "primary dysmenorrhea" and often occurs during adolescence.

In contrast, pathological changes are called "secondary dysmenorrhea", which has too many causes: abnormal reproductive tract structure, uterine hematoma caused by surgery or other reasons, pelvic inflammatory disease or fallopian tube and ovarian abscesses, endometriosis, adenomyosis, etc. can all cause dysmenorrhea symptoms, but the most common ones are endometriosis and adenomyosis.

Different types of dysmenorrhea have different effects on pregnancy.

Primary dysmenorrhea is a common phenomenon

In social surveys, the incidence of primary dysmenorrhea can be as high as 93%[2], which shows that dysmenorrhea is actually a very common phenomenon.

Currently, it is known that there are two factors related to primary dysmenorrhea. One is that the endometrium produces too much prostaglandin F2α (PGF2α), and the other is that the ratio of prostaglandin F2α to prostaglandin E2 increases. This phenomenon of the endometrium is only found in menstrual cycles with regular ovulation [3]. In other words, primary dysmenorrhea is closely related to regular ovulation. It is not the cause of infertility, but rather a symptom that only occurs when the body matures and is suitable for pregnancy.

Some people may wonder, I didn't have dysmenorrhea when I first had my period, but it started to hurt after a few years. Isn't it because I didn't pay attention to keeping warm that caused "uterine cold"?

The truth is that ovulation does not occur normally in the years before menarche.

The hormone pathway that controls the menstrual cycle is called the hypothalamus-pituitary-ovarian axis. It is suppressed after birth and menarche occurs after puberty, but the ovaries cannot ovulate normally at this time. It will take several months to several years for the hypothalamus-pituitary-ovarian axis to fully mature, and then ovulation and menstruation will become regular, and dysmenorrhea will follow. For most people, it takes 4 to 5 years to mature. [4]

In other words, most people do not have dysmenorrhea from the beginning, but often gradually develop pain in high school or college. And dysmenorrhea is not caused by drinking herbal tea, eating cold drinks, exercising during menstruation, or other problems that are not noticed, which lead to the so-called "uterine cold", but just because the body is mature and ovulation is regular. A few people do not have dysmenorrhea because they pay special attention to keeping warm and avoid uterine cold, but because they are "the chosen ones".

Image source: pixabay

Secondary dysmenorrhea and infertility

Primary dysmenorrhea has no other physical damage except pain, but secondary dysmenorrhea is different. There are often various causes behind it. Whether it is structural abnormalities or inflammatory reactions caused by infections, they will affect normal conception.

So, back to the main topic of this article, are people with dysmenorrhea difficult to conceive? Many people with secondary dysmenorrhea are.

But in addition to being concerned about the chances of conception, doctors need to find the underlying cause and pay attention to the ongoing damage to the body.

Symptoms of primary dysmenorrhea usually appear shortly before the onset of menstruation or during menstrual bleeding, and most of them can be relieved within 12 to 72 hours, and the symptoms are basically similar every month. Patients with secondary dysmenorrhea, such as those with uterine fibroids, may also suffer from menorrhagia, prolonged menstruation, and a series of problems due to anemia in addition to dysmenorrhea; patients with pelvic inflammatory disease may develop chronic pelvic pain, which occurs from time to time; patients with endometriosis and adenomyosis often have worsening pain, and some people even suffer from pain every day and have no quality of life.

However, it is not easy to determine the cause of secondary dysmenorrhea. If you feel that your dysmenorrhea has suddenly worsened or is getting more severe, or if there are other abnormal symptoms during menstruation, it is best to go to the hospital for help from a doctor.

How to deal with dysmenorrhea?

In addition to managing pain, in order to deal with secondary dysmenorrhea, finding and treating the disease behind secondary dysmenorrhea can solve the root problem. Even those who are anxious to get pregnant need to eliminate or control the primary disease to increase the chance of conception and ensure the safety of pregnant women and fetuses during pregnancy.

Dealing with primary dysmenorrhea is much simpler. Since we already know that it is related to prostaglandins, we just need to prevent them from being produced. There are two main methods:

1. Non-steroidal anti-inflammatory drugs, common ones such as ibuprofen, ketoprofen, naproxen, etc. can be used.

These drugs can block the synthesis of prostaglandins, so the sooner you take them, the better. People with severe symptoms can start taking the medicine one day in advance.

If ibuprofen and the like are not effective, you can also try fenamic acid drugs, such as mefenamic acid (a doctor's prescription is required). This drug can both inhibit the synthesis of prostaglandins and prevent the already synthesized prostaglandins from taking effect. It may have a better effect on people with particularly severe dysmenorrhea.

Nonsteroidal anti-inflammatory drugs are not addictive, and the duration and dosage of medication for the treatment of dysmenorrhea are not long. If there are no contraindications and serious adverse reactions, you can use them with confidence. However, most nonsteroidal anti-inflammatory drugs are irritating to the gastrointestinal tract. Although most people are not affected, in order to reduce the risk of gastrointestinal reactions, it is best not to take them on an empty stomach. It is safer to take them with food.

2. Oral combined short-acting contraceptives.

If there is a need for contraception, or if you cannot take nonsteroidal anti-inflammatory drugs, combined short-acting contraceptives are also an option. The mechanism of contraception of estrogen-progestin contraceptives is to inhibit ovulation. According to the mechanism of primary dysmenorrhea, inhibiting ovulation can prevent the synthesis of prostaglandins from the source, and naturally solve the problem of dysmenorrhea.

In clinical practice, when a single oral medication is ineffective for primary dysmenorrhea, a combination of anti-inflammatory drugs and contraceptives is sometimes used.

Studies have shown that local heat can also help relieve dysmenorrhea[5]. People with mild symptoms may want to try it, or use it in combination with medication. In my personal experience, the difference between heat and ibuprofen is like the difference between a fan and air conditioning.

Low-quality evidence suggests that exercising for 45 to 60 minutes three or more times a week, regardless of the intensity, can help relieve dysmenorrhea.[6] Considering the overall health benefits of exercise, it may be worthwhile for everyone with dysmenorrhea to give it a try.

References

[1] Xie Xing, Kong Beihua, Duan Tao (eds.); Lin Zhongqiu, Di Wen, Martin, Cao Yunxia, ​​Qi Hongbo (co-eds.). Obstetrics and Gynecology, 9th edition [M]. Beijing: People's Medical Publishing House, 2018

[2]CampbellMA,McGrathPJ.Useofmedicationbyadolescentsforthemanagementofmenstrualdiscomfort.ArchPediatrAdolescMed.1997;151(9):905-913.doi:10.1001/archpedi.1997.02170460043007

[3]WillmanEA,CollinsWP,ClaytonSG.Studiesintheinvolvementofprostaglandinsinuterinesymptomatologyandpathology.BrJObstetGynaecol.1976;83(5):337-341.doi:10.1111/j.1471-0528.1976.tb00839.x

[4]SmithRP.Primarydysmenorrheaandtheadolescentpatient.AdolescentPediatricGynecology1988;1:23.

[5]AkinMD,WeingandKW,HengeholdDA,GoodaleMB,HinkleRT,SmithRP.Continuouslow-leveltopicalheatinthetreatmentofdysmenorrhea[J].Obstetricsandgynecology,2001,97(3).

[6]ArmourMike,EeCarolynC,NaidooDhevaksha,AyatiZahra,ChalmersKJane,SteelKylieA,deManincorMichaelJ,DelshadElahe.Exercisefordysmenorrhea[J].TheCochranedatabaseofsystematicreviews,2019,9.

Author: Doctor Feidao Duanyu

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association