Horizon Prime Hospital - Thane

Crippling Pain ? Painful Periods? You are not Alone, It Could Be Dysmenorrhea
Dysmenorrhea Affects Nine Out Of Ten Women
Nine out of 10 women suffer from period pain — sometimes crippling. Many may say that over a period of time that they are used to such crippling pain. A young girl, normally are informed of the menarche – their first menstrual cycle – one of approximately 500 over the course of a lifetime. Mothers would inform their daughters that you can expect some discomfort, but given no hint that for some this pain would go beyond mild and descend into pretty damn awful. Period pain is caused by contractions in the uterus. The blood vessels in the muscle wall are compressed by the contractions, which cut off blood supply to the womb, starving it of oxygen and adding to the discomfort.

Pain experienced during the menstrual cycle is referred to as dysmenorrhea. It is a common symptom wherein there is usually a sharp pain in the lower abdominal area that may radiate to the thighs as well. It normally starts on day 1, and peaks as the flow becomes heaviest during days 2 or 3. If you have severe or unusual menstrual cramps that last for more than 2-3 days, you should consult a gynaecologist immediately.

What you’re feeling is a tightening and relaxing of your uterus. The muscles in your uterus contract in order to shed your uterine lining. Experts aren’t entirely sure why some people have more painful periods, but they think it may be because they have higher levels of prostaglandins. There is also a clear explanation other than everyone’s body is different.

Dr Hrushikesh Vaidya, Medical Director and Chairman, Horizon Group of Hospitals said “Minor aches and pains during menstruation are normal. If you get extremely painful periods — dysmenorrhea — you don’t have to suffer silently. There are ways to make menstrual cramps less painful Dysmenorrhea is common and usually independent of, rather than secondary to, pelvic pathology. Dysmenorrhea occurs in 50% to 90% of adolescent girls and women of reproductive age and is a leading cause of absenteeism. Menstrual pain is a prevalent problem amongst women of reproductive age and can affect their everyday life and professional environment, requiring work leaves on some occasions”.

Dr Ria Vaidya, CEO, Horizon Group of Hospitals said “Menstrual cramps themselves usually don’t cause complications, other than disrupting your daily life. But if a medical condition is causing painful periods, there can be complications. Hence, it’s important to consult a gynaecologist immediately so they can rule out any underlying cause for your period pain”.

Dr Manali Shilotri, Leading Gyanecologist and Consultant Horizon Prime Hospital said “Dysmenorrhea is the medical term for painful periods (menstruation) or menstrual cramps. In addition to cramping, you might have other symptoms, such as nausea, fatigue and diarrhea. It’s most common to have menstrual cramps the day before or the day you start your period. For most people, symptoms subside after about two or three days. Mild to moderate menstrual cramping is normal. But some people have such severe pain during their period that it interferes with their day-to-day life and prevents them from doing things they enjoy. Medication and other treatments can help with painful periods”.

Dr Manali Shilotri further said “Painful menstrual cramps occur due to a chemical called prostaglandin which causes the uterus to contract. During menstruation, if the uterus contracts too strongly, it can press against nearby blood vessels cutting off the oxygen supply to muscle tissue, causing pain”.

Dr Manali Shilotri added “It’s normal to have some pain during menstruation. About 60% of women with a uterus have mild cramps during their period. About 5% to 15% of people report period pain that’s so severe that it affects their daily activities. However, this number is likely higher and we as doctors believe many people don’t report menstrual pain. In most cases, painful periods become less painful as you get older. They may also improve after giving birth”.

There are two types of dysmenorrhea: primary and secondary.

1. Primary dysmenorrhea : Primary dysmenorrhea, the most common type of dysmenorrhea is the name for menstrual cramps that come back every time you get period, but aren’t due to another medical condition. Common menstrual cramps that are not due to any other diseases, ranging from mild to very severe in your lower abdomen, back or thighs. Pain usually begins one or two days before you get your period or when the bleeding actually starts. The pain usually subsides within two or three days. Pain can also be accompanied by nausea, vomiting, feeling tired, and even loose motions. Common menstrual cramps can get better with age and after giving birth.Primary dysmenorrhea is influenced by many factors:
   • Age less than 20 years
   • Never having given birth
   • Heavy menstrual flow
   • Belonging to higher socioeconomic status
   • Severe dieting
   • Being underweight or obese
   • Smoking
   • Alcohol consumption
   • Social isolation
   • Depression and anxiety
2. Secondary dysmenorrhea : If you have painful periods because of a condition or an infection in your reproductive organs, it’s secondary dysmenorrhea. Pain from secondary dysmenorrhea usually begins earlier in your menstrual cycle and lasts longer than typical menstrual cramps. For example, you may experience cramping several days before your period and the pain may last until the bleeding completely stops. Secondary dysmenorrhea is less common. Other complaints of nausea and vomiting are usually not there.

Secondary Dymenhorrea Causes : Menstrual cramps due to other problems of reproductive organs can include:
Endometriosis: A condition in which the inner lining of the uterus is found outside of it, most commonly forming a cyst in the ovary. This lining bleeds during menses causing swelling, scarring and pain.
Adenomyosis: A condition in which the lining of the uterus grows into the muscle of the uterus causing the uterine size to increase and leading to heavy period flow and pain.
Infection or pelvic inflammatory disease: A bacterial infection which starts in vagina and uterus and spreads causing inflammation and pain. It is often accompanied by vaginal discharge and pain during intercourse.
Fibroids: Benign tumours of the muscles of the uterus which can cause painful periods, heavy flow and even difficulty in conception.
Cervical stenosis : A condition where your cervix narrows due to surgery, treatment or other condition.
Congenital Conditions : Certain conditions you are born with can cause painful menstruation. This may include an irregularly shaped uterus or other conditions affecting your ovaries or fallopian tubes.

Diagnosis
If you have severe or unusual menstrual cramps or cramps that last for more than three days, contact a healthcare provider. Both primary and secondary menstrual cramps are treatable, so it’s important to get checked.

Tests

• Pelvic Exam : Pelvic Exam is by placing gloved fingers into your vagina. During this exam, your provider will also insert a speculum into your vagina. This allows them to get a better look at your vagina and cervix. They may take a small sample of vaginal fluid for testing. The goal of the exam is to determine if a medical condition is causing painful periods. If there isn’t an apparent cause, your provider will diagnose you with primary dysmenorrhea.
• Ultrasound : Ultrasound uses sound waves to create images of your uterus, ovaries and other reproductive organs.
• Hysteroscopy : Your provider uses a thin, lighted device to see inside your uterus. The device transmits images of your uterus to a screen.
• Laparoscopy : Your provider makes tiny incisions in your abdomen and then uses a laparoscope (a thin tube with a light and camera at the end) to view your pelvic organs.

If those tests show you have a medical condition causing painful menstruation, your healthcare provider will discuss treatment with you.

Treatment

• • Non-steroidal anti-inflammatory drugs and other pain relievers
  • Hormonal medications

Other ways to reduce menstrual cramps: There are several treatments for menstrual cramps that don’t involve medication. Some of these are:

• • • Using a heating pad or hot water bottle on your lower back or abdomen when you have cramps.
    • Getting extra rest.
    • Avoiding foods that contain caffeine.
    • Avoiding smoking cigarettes and drinking alcohol.
    • Massaging your lower back and abdomen.
    • Exercising regularly. People who exercise tend to have less menstrual pain.

If testing shows that you have secondary dysmenorrhea, your provider will discuss treatment for the condition causing you pain. This might mean oral contraceptives, other types of medications or surgery.

Conclusion
Dr Manali Shilotri concluded by saying contact your healthcare provider if you have painful periods that prevent you from doing your normal tasks. Mild cramps are normal. But severe crippling pain that prevent you from going to school or work may mean you need treatment. It may be helpful to keep track of your periods and the days on which pain is the worst so you can share with your doctor. If you notice other symptoms, like headaches or heavy bleeding, you should keep track of those, too.