Painful Periods or Dysmenorrhea

What is Dysmenorrhea?

Period pain or dysmenorrhea is a condition of painful menstrual periods. Menstrual cramps or pain is felt in the abdominal areas. It can occur before the menstrual cycle begins and can continue for 2 to 3 days.

Primary dysmenorrhea is a common painful condition in women with no abnormalities in the pelvic region. Women may experience severe pain before or at the onset of menstrual periods, and the pain persists for 2–3 days.

Cause of Dysmenorrhea

Primary Dysmenorrhea

Occurs at the onset of menarche [when periods first commence] or soon after.

Primary dysmenorrhea is caused by the elevated levels of the hormone prostaglandin produced by the tissues lining the uterus (womb). Prostaglandin triggers the uterine muscles to contract and push the uterine bleeding/clots out of the body through the cervix.

Secondary Dysmenorrhea

Secondary dysmenorrhea is a painful condition caused by other gynaecological problems. It first occurs well after menarche [i.e.when your periods first appear]. This kind of pain begins early in the menstrual cycle and lasts longer than primary dysmenorrhea.

Conditions that may cause secondary dysmenorrhea include

• endometriosis,
• fibroids,
• infection,
• ovarian cysts,
• narrow cervix,
• abnormal pregnancy, and
• intrauterine device for birth control.

Symptoms of Dysmenorrhea

Some of the commonly observed symptoms are

• back pain,
• leg pain,
• nausea,
• vomiting,
• diarrhoea,
• headache,
• irritability,
• weakness and
• fainting.

Diagnosis of Dysmenorrhea

Dr Tukner will perform a pelvic examination to identify if there are any other problems associated with menstrual cramps.

Blood tests and cervical cultures will confirm if there is any sign of infection. Other diagnostic tests may be required which include an MRI scan and ultrasound scan.

Non-surgical Treatment for Dysmenorrhea

If the menstrual cramps are because of the underlying medical conditions, then treating the conditions will help to relieve pain.

The conservative approach includes non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain by decreasing prostaglandin production and more effective if commenced before the period commences and/or the contraceptive pills which decrease the production of prostaglandins by preventing ovulation.

NSAIDs are contraindicated if you have a history of kidney and stomach problems. The other home remedies such as

• a heating pad to the pelvic area,
• regular exercises,
• massage to the back and abdomen,

may help to treat period pain.

Surgical Treatments for Dysmenorrhea

Surgery is very rarely conducted for patients with dysmenorrhea and usually only when conservative measures are not successful.

Some of these procedures are reserved for women who do not wish to conceive or finish their family or certain age groups. Some of the procedures carried out are laparoscopy and hysteroscopy

• Mirena IUD cause hormonal thinning of the endometrium and reduces and even quite possibly stop periods
• Endometrial ablation – In this procedure, the superficial tissue layer lining the uterus is destroyed. The tissue is destroyed by several ablation techniques such as laser beam, freezing, or heating. It is recommended in patients who have heavy uterine bleeding
• Hysterectomy – It is the surgical removal of the entire uterus. It is recommended if you have fibroids, uterine prolapse, cancer in the uterus, and uncontrollable vaginal bleeding. This procedure will stop periods. It is not recommended for women who want to have children.