By Dr. Payal Chaudhary
More than half the women who menstruate feel pain during their menstruation, which is also called as dysmenorrhea. This pain is felt for one to two days for majority of women. But for some women, the pain is so severe that it keeps them from doing their normal activities for several days a month. Sometimes the severe pain comes with other symptoms, including diarrhoea, nausea, vomiting, headache, and dizziness.
There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea is the cramping pain that comes before or during a period. This pain is caused by natural chemicals called prostaglandins that are made in the lining of the uterus. Prostaglandins cause the muscles and blood vessels of the uterus to contract. On the first day of a period, the level of prostaglandins is high. As bleeding continues and the lining of the uterus is shed, the level goes down. This is why pain tends to lessen after the first few days of a period.
Primary dysmenorrhea begins soon after a girl starts having menstrual periods. In many women with primary dysmenorrhea, periods become less painful as they get older. This type of period pain also may improve after start of sexual activity or giving birth.
Secondary dysmenorrhea is caused by a disorder in the reproductive organs. The pain tends to get worse over time and it often lasts longer than normal menstrual cramps. For example, the pain may begin a few days before a period starts, may get worse as the period continues and may not go away after it ends.
Common reasons for secondary dysmenorrhoea are:
Endometriosis: Endometriosis is a condition where tissue similar to the lining of the uterus, called as endometrium, starts growing in other areas of the body, such as on the ovaries and fallopian tubes, behind the uterus, and on the bladder. Like the lining of the uterus, this tissue breaks down and bleeds in response to changes in hormones. This bleeding can cause pain, especially around the time of a period. Scar tissues, called adhesions, may form inside the pelvis where the bleeding occurs. Adhesions can cause organs to stick together, also causing pain and increasing the pain over time.
Fibroids: Fibroids are growths that form on the outside, inside, or in the walls of the uterus. Fibroids located in the wall of the uterus can cause pain. Small fibroids usually do not cause pain.
Adenomyosis: Adenomyosis develops when tissue that normally lines the uterus begins to grow in the muscle wall of the uterus. This condition is more common in older women who have had children. This leads to globular increase in the size of uterus and also severe pain during periods.
Problems with the uterus, fallopian tubes, and other reproductive organs: Certain genetic factors can result in pain during menstruation.
Other conditions: Some medical conditions can flare up during a period and cause pain.
You must seek an Obstetrician-Gynaecologist consultation if you have severe pain during periods. Most women with primary dysmenorrhoea can use home remedies like placing a hot pack on the lower abdomen or take a painkiller once or twice a day. Occasional use of pain killers, that is, only during periods is not harmful for the body and can provide much needed relief from period pain. If pain killers are not relieving pain, then one must seek help to evaluate the cause of this pain.
An ultrasound exam may be done when pain is not relieved with medication. Rarely one may need to undergo laparoscopy —a procedure that lets an ob-gyn view the organs in the pelvis. With laparoscopy, a small incision (cut) is made near the belly button. A thin, lighted camera—a laparoscope—is inserted into the abdomen.
During laparoscopy, the type of surgery depends on the cause of your pain:
Fibroids can sometimes be removed with surgery.
Endometriosis tissue can be removed with surgery. In some cases, the tissue returns after the surgery, but removing it can reduce the pain in the short term. Taking hormonal birth control or other medications after surgery for endometriosis may delay or prevent the return of pain.
Hysterectomy may be done for adenomyosis if other treatments have not worked. Hysterectomy also may be recommended for other conditions when they cause severe pain. This surgery usually is a last resort.
This article has been produced in association with Rainbow Children’s Hospital.
Dr PAYAL CHAUDHARY
Senior Consultant - Obstetrics & Gynecology
BirthRight By Rainbow Hospitals, Malviy Nagar, Delhi