Painful or difficult menstruation - termed dysmenorrhea, is
one of the commonest gynaecological complaints in clinical medicine globally.
It is often characterized by mild to severe pain before or during menstruation.
When moderate or severe, it is of economic importance as it causes a loss of
productivity at work or school, and for activities of daily living. It is also
psychologically draining for women that are affected.
What causes Dysmenorrhea?
Menstrual pain is caused by an exaggeration of the complex processes and hormones (chiefly prostaglandin) involved in menstruation. When it happens in the absence of any pelvic diseases, it is also called primary dysmenorrhea and it is commonest in teenagers. Here, the pain often starts just before or at the onset of menstruation and lasts 8 to 72 hours. The pain is often superimposed with lower abdominal cramps and can be felt at the back and thighs. It may also cause malaise, nausea, feeling bloated, vomiting, fatigue, anxiety, diarrhoea and headaches. Pin severe cases, dizziness and fainting spells can occur.
In some cases, menstrual pain is caused by a concurrent disease condition in the reproductive system which further accentuates the pain or the release of hormones involved in menstruation. Some examples of disease condition that can worsen menstrual pain include fibroids, pelvic inflammatory disease, endometriosis, and ovarian cysts. This type of menstrual pain is also called secondary dysmenorrhea, which is commonest in women who are in their mid to late twenties. Here, the pain often lasts throughout the cycle and only ceases a few days after menstruation. It is also associated with pain during sex, vaginal discharge and infertility.
Additionally, menstrual pain is sometimes caused or worsened by medications used for other conditions like contraception.
Who is affected?
Menstrual pain affects about 50 ? 80% of women of all racial backgrounds who are menstruating, with 10% describing severe symptoms. It is commonest in women who:
- Started menstruation at a young age (less than 11)
- Are between late teens and mid-twenties
- Smoke cigarettes
- Are obese
- Have never had a baby
- Have long flow days
- Have heavy periods
- Have a family history of menstrual pain
- Rarely consume fruits, fish and vegetables.
How Is Menstrual Pain Treated?
Treatment follows consultation, which includes a physical examination and may require some blood, urine or radiological investigations for a diagnosis to be made. Usually, menstrual pain is a standalone entity but may be a symptom of an underlying condition, especially if there are other symptoms like vaginal discharge, pain in between cycles and pain during sex. When a diagnosis is made, your healthcare provider will proffer treatment via the following ways:
These are relatively successful in 60 to 100% of cases. The commonly used medications are painkillers, or hormonal pills typically used for contraception.
These include smoking cessation, reducing alcohol intake, dietary modifications to include fruits and vegetables and exercising.
This is undertaken in the event of an accompanying identified pelvic condition and to make a proper diagnosis.
Unlike other treatment modalities, these techniques vary in efficacy. Examples include warm/hot water application, massage therapy, yoga, TENS and acupuncture