Menstrual Pain *DYSMENORRHEA*

What are menstrual pains?

These are painful periods, including severe cramps that occur during menstruation. In teens, menstrual cramps are almost always caused by too much of prostaglandins, not necessarily by the presence of a disease condition. In older women however, the pain could be associated with condition such as uterine fibroid or endometriosis. In many cases the root cause of the pains are poorly understood. Generally, women that have higher levels of prostaglandin or those who are more sensitive to it tend to have more painful periods. Whether the menstrual pain is light, moderate or severe, the pain generally subsides just as menstruation tapers off.

How common are menstrual cramps?

An estimated 50% of women are thought to experience some level of menstrual cramps, of which about 15% of them experience severe cramps. Studies have shown that up to 90% of adolescent girls experience menstrual cramps.

There are two types of menstrual pain

1.        Primary dysmenorrhea: When the menstrual pains are not associated with any underlying disease, disorder or structural abnormality either inside or outside the womb (uterus).

2.       Secondary dysmenorrhea: When period pains are linked to an underlying disease, disorder or structural abnormality either inside or outside the uterus. Some of the causes may include:

                i.      Endometriosis (cells from the uterine lining are located in other areas of the body)

                ii.      Uterine fibroids (non-cancerous uterine growths that respond to estrogen levels)

                iii.      Adenomyosis (a benign condition in which the cells of the inner uterine lining invade         its muscular wall, the myometrium)

                iv.      Pelvic inflammatory disease (PID)

                 v.      Adhesions (abnormal fibrous attachments between organs)

                 vi.      Use of an intrauterine device (IUD) for contraception

Causes of menstrual pain

Usually every month, in every woman who has attained puberty, the inner lining of the uterus (womb) is built up in preparation for any possible pregnancy. When ovulation occurs, eggs are released. These eggs have to be fertilized for pregnancy to happen. However, if there is no pregnancy, the already built up uterine lining is no longer needed and is eventually discarded in the form of menstrual flow. This is then replaced by a new lining in the next monthly cycle.

During the process of breakdown of this uterine lining, some compounds are released. These includes chemicals such as prostaglandins, especially a subtype (PGE2), which causes the muscle of the uterus to contract causing the usually pains. The contraction is also helpful in order to get rid of the broken down inner uterus lining out of the body. There may not be an identifiable cause of your painful menstrual periods. Certain women are at a higher risk for having painful menstrual periods.

Risk factors include:

·         being under age 20

·         having a family history of painful periods

·         smoking

·         having heavy bleeding with periods

·         having irregular periods

·         never having had a baby

·         having experienced early puberty, which is puberty before the age of 11

Hormone-like substances called prostaglandins trigger muscle contractions to help your uterus expel its lining each month. These contractions can cause pain and inflammation. Women with higher levels of prostaglandins may experience more severe menstrual cramping and pain. (Mayo Clinic)

In some cases, such as with secondary dysmenorrhea, painful menstrual periods can be the result of an underlying medical condition, such as:

·         premenstrual syndrome (PMS)

·         endometriosis (a painful medical condition in which cells from the lining of the uterus grow in other parts of the body)

·         fibroids in the uterus (noncancerous tumors)

·         pelvic inflammatory disease, an infection of the uterus,fallopian tubes, or ovaries often caused by sexually transmitted infections

·         sexually transmitted infections (STIs)

·         adenomyosis, a rare condition in which the uterine lining grows into the muscular wall of the uterus cervical stenosis, a rare condition in which the cervix is so small it slows menstrual flow (NLM)

Certain types of birth control, specifically intrauterine devices (IUDs) made of copper, are associated with increased pain during menstruation

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When To Call a Doctor

If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to your gynecologist about your symptoms. Talk to your doctor if you experience any of the following:

·         pain after IUD placement

·         painful menstrual periods that have lasted longer than three months

·         passing blood clots

·         cramping accompanied by diarrhea and nausea

·         pelvic pain when not menstruating

·         Sudden cramping or pelvic pain could also be signs of infection. 

An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility. If you have symptoms of an infection, seek prompt medical attention.

Symptoms of menstrual pain?

·        Lower abdominal cramps (pains)

·        Diarrhea

·        Tiredness (fatigue), weakness and fainting

·        Headaches

·        Low back pain

·        Nausea and vomiting

Please note that other diseases conditions could also present with similar symptoms, so it’s important to contact a doctor to make accurate diagnosis and prescribe proper medications.

Treatment options for menstrual pain

1.      Analgesics (painkillers): These drugs are very effective for treating menstrual pain and discomfort. This could include paracetamol, naproxen, ibuprofen and aspirin.

They block the action of prostaglandin which is the main culprit in menstrual pain. In some countries such as the UK aspirin is not recommended for girls under the age of 16.  These types of painkillers do not require prescription. Prescription NSAIDs available for the treatment of menstrual cramps include mefenamic acid and meclofenamate.

2.      Contraceptives: Oral contraceptives often bring relief to menstrual pain. They are said to suppress the synthesis of prostaglandins, and therefore limits uterine contractility.

3.      Exercise: Mild to moderate exercise helps reduce the level of discomfort and pain experienced by women with menstrual pain.

4.      Relaxation techniques: Different relaxing methods such as breathing exercises, massage and medication could help in relieving pain during menstruation.

5.      Hot water bottle:  Holding one against the abdomen may help in reducing discomfort.

6.      Oral supplements: Omega-3 fatty acids, magnesium, vitamin E, and vitamin B1 (thiamine) supplements have been indicated as effective in treating menstrual pain.

7.      Warm bath: Apart from helping the person relax, a warm bath may also provide some pain/discomfort relief. 

References

·         Menstruation Disorders, MedscapeReference:  http://emedicine.medscape.com/article/953945-overview

·         How to relieve menstrual cramps, About.com Women’s Health http://womenshealth.about.com/cs/crampsmenstrual/ht/menstrualcramps.htm