Being a woman sometime or other time we have experienced pain during the periods.
It is one of the most common disorders related to periods. Though majority of times it is self-resolving after periods. But can cause serious concern for those who suffer it severely and feel restricted due to pain.
Let’s understand this common concern and how to reduce its adverse impact on our life.
What is dysmenorrhea?
Dysmenorrhea is a medical term for difficult and painful periods (menstruation).
More than half of the women feel menstrual pain during their monthly period for at least 1-2 days.
It can be light for some women but for some it can negatively affects quality of life and sometimes results in activity restriction and lost work and school days, missing sports or social events etc.
What is the cause?
There could be several factors causing menstrual pain but primarily occurs due to a naturally occurring chemical in the lining of uterus (Endometrium) Prostaglandins. Prostaglandins causes uterus to contract and allow blood to release. Pain usually starts before period starts as prostaglandins increases in the lining of uterus.
Other factors are sensitive nervous system, which causes more intense response to pain. Genetic factors and pelvic diseases may also contribute to pain.
There are several risk factors which enhances chances of having pain during periods like
- Heavy menstrual loss
- Premenstrual symptoms
- Irregular menstrual cycles
- Clinically suspected pelvic inflammatory disease
- Age younger than 30 years
- Menarche before 12 years of age
- Family History
- Never having given birth
- Smoking /Alcohol
- Stress and Anxiety
- Sedentary life style
- Excessive overweight or underweight
- Sexually transmitted diseases
Types of Dysmenorrhoea
It is pain that comes from having menstrual period in absence of any other illness. Usually begins soon after having first menstrual periods. Commonly occurs in young women and decreases as they get older and after childbirth. This pain is relieved after menstrual period is over.
It Occurs specifically due to diseases of pelvic organs. Usually seen later in life and pain gets worsened over a period of time.It lasts longer than normal menstrual cramps. It may begin days before menstrual periods and may not end even after periods got over.
There is usually dull or sharp throbbing cramping pain in lower abdomen during menstrual periods. Primary Dysmenorrhoea usually starts with onset of menses and lasts for 2-3 days
May be associated with
- Pain in lower limbs.
- Loose motions,
- Bloating of tummy
In Secondary dysmenorrhea symptoms vary with underlying disease but commonly
- Occurs after menstruation
- Pain may precede several days before periods and last several days after menstrual periods
- May be associated with pain during sex.
- Discharge from vagina
Common illnesses causing Dysmenorrhoea are endometriosis (lining of uterus grows in other pelvic organs), pelvic inflammatory disease, fibroids (growth in wall uterus) and adhesions, cervical obstruction, ovarian cyst etc.
Intrauterine contraceptive device (IUD) and sometimes tampons can also contribute to pain in some.
Most women can identify menstrual pain without help of physician.
Investigations depends upon severity of symptoms,incapacitation and pelvic illness.Your doctor may give a trial of medicines before resorting to invasive investigations especially in a young unmarried girl.Your doctor will assess and evaluate you by doing following examinations as required
- Complete history
- Pelvic and abdominal examination
- Vaginal swab/pap smear
- Pelvic Ultrasonography
- CT scan/MRI scan
- Hysteroscopy/Laparoscopy etc.
How to relieve symptoms and when to see a doctor?
Not all with menstrual pain needs treatment many times pain is self-limiting.It is rare to see severe primary dysmenorrhea above the age of 35 years.sometimes it is cured after pregnancy.
Care can be taken at home initially to reduce discomfort and pain
Medication – You can take over the counter non-steroidal anti-inflammatory (NSAIDS) tablet like paracetamol,Ibuprofen etc.which are available in medical store without prescription.One of those can be taken to relieve symptoms.(Please avoid prolonged self medications).
Birth Control Pills–Birth control pills and other forms of hormonal birth control (eg, patch, vaginal ring, injection, hormone-releasing intrauterine device, contraceptive implant) also represent effective treatments for women with dysmenorrhea who are not trying for pregnancy. These treatments work by thinning the lining of the uterus, where prostaglandins are formed, thereby decreasing the uterine contractions and menstrual bleeding that contribute to pain and cramping.
- Hot fomentation on lower abdomen and back hot water bath, heating pads, hot water bags, hot moist pack etc. can significantly reduce the pain
- Do gentle massage on lower abdomen with your fingertips.
- Lye down with legs elevated.
- Regular exrecise release endorphins which leads to pain relief.
Diet to reduce pain and inflammation
- During acute pain warm beverages-green tea, ginger tea, chamomile tea etc.
- Avoid –excessive salt, sugar, fats and food rich in caffeine
- Stop smoking and alcohol
- Can take food rich in Omega 3 and Omega 6 fatty acid can reduce inflammation such as flaxseed, evening primrose oil etc.
- Vitamin E and B-complex and magnesium can be taken with consultation of your doctor.
Relaxation therapies can help to reduce pain and stress associated with dysmenorrhea, meditation is also useful to relieve pain
Consult your doctor if…
- When pain is getting worse and not relived by home remedies.
- Pains are lasting longer than menstrual periods.
- If Symptoms becomes more severe and frequent
- Increased menstrual bleeding and blood clots.
- Abrupt change in severity of pain with other associated symptoms like nausea; vomiting, rapid heart rate etc. may be associated with acute medical emergency.
- Fever with vaginal discharge-fever associated with menstrual pain and foul-smelling vaginal discharge before or after periods may suggest pelvic infection.