Menstrual Pain (Dysmenorrhea)

Health Matters by Dr. Longwap AbdulAziz Saleh

e-mail: longwapabdul@yahoo.com | Text: 08039537913

Dysmenorrhea, commonly known as menstrual pain is lower abdominal cramps caused by muscular contractions and release of hormones like prostaglandins that is experience by some women during menstruation. Although dysmenorrhea is not commonly a life threatening condition, it can be debilitating and life threatening for some women. It has made quite a number of adolescence and adult to detest menstruation. So many would have a preferred not to be seeing their monthly period if they have the chance. If not that it is one of he believed criteria for woman to be certified reproductive.

Types

Primary dysmenorrhea

Secondary

Primary is painful menstrual flow in women with normal pelvic anatomy without any history of sexually transmitted diseases and it usually starts during adolescence age. Here the woman experience crampy pelvic pain or lower abdominal pain which normally starts 3-7days before the onset of menstruation with the peak of pain being experienced on the 1st day of the period. This pain can last for 1-3days during the period depending on the individual, but for majority the pain last for a day.

Secondary is seen in women with pelvic organ disease or pathology. The following may indicate secondary dysmenorrhea;

Dysmenorrhea beginning in the 20s or 30s, after previous relatively painless cycles

Heavy menstrual flow or irregular bleeding

Dysmenorrhea occurring during the first or second cycles after menarche

Pelvic abnormality with physical examination

Poor response to non-steroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives (OCs)

Infertility

Dyspareunia

Vaginal discharge

Prevalence of Dysmenorrhea

Primary dysmenorrhea affects about 50% of post-pubertal females; females that have passed ages of 12-14yrs. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. The prevalence in adolescent females has been reported to be 67.2% by one study and 90% by another.  It has been stated that there is no significant difference in prevalence or incidence between races

What bring about this discomfort (dysmenorrhea) that is the pathogenesis?

Dysmenorrhea occurs as a result of the release (in excess) of a hormone like substances called prostaglandin in the myometrium (muscles of the uterus). The hormones which is a potent myometrial stimulant and vasoconstrictor causes the muscles of the uterus (womb) to contract to bring about the crampy pain that the woman feels during her period. Vasopressin and leukotriene’s are also associated with menstrual pain the former which plays a role by increasing uterine contractility and causing pain, while the later increases the sensitivity of the pain fibers in the uterus.

Women at risk

You may be at greater risk of menstrual cramps if:

You’re younger than age 30

You started puberty early, at age 11 or younger

You have heavy bleeding during periods (menorrhagia)

You have irregular menstrual bleeding (metrorrhagia)

You’ve never given birth

You have a family history of dysmenorrhea

You’re a smoker

Anxiety

Depression

Women with STDs and PID

Clinical features

This varies from one woman to the other, but one thing is common among women that experience dysmenorrhea or abdominal cramps. Pain radiating from the lower abdomen down to the thighs and legs. Nausea, vomiting, diarrhea, fatigue, depression, Irritability, cramping of labor like pain, pain is constant and radiating to the back or thigh. Normal starts in 20-30 seconds after previous relative painless cycles, heavy menstruation flow or irregular bleeding, infertility, dyspareunia (painful intercourse) and poor response to NSAID and oral contraceptives.

Treatment

Aim of treatment is to provide relief to the woman for those symptoms of dysmenorrhea and equally inhibit the underlying process that cause the symptoms

NSAID is always the first approach taken by medical personnel and studies has shown that NSAID is effective for treatment of dysmenorrhea. eg of this drugs includes ibuprofen, aspirin, diclofenac. These drugs works by inhibiting cyclooxygenase (COS), thus inhibiting prostaglandin synthesis which brings about the menstrual pain. These drugs work best when taken before the period starts.

Prolonged cycle oral contraceptive or intraviginal use of contraceptive pills can also be used for the treatment of dysmenorrhea.

Surgical

In rare occasion a surgical approach may be considered for women with severe second degree dysmenorrhea eg. Hysterectomy

Home remedies

Heat application: heat a sachet of water, rap it with a towel and apply it on the lower abdomen. It gives some level of relief.  Hot Water bottle is the best if it is available.

Avoid sugary things because they tend to aggravate pain

Taking of warm water

Menstrual cramps don’t cause any other medical complications, but they can interfere with school, work and social activities.

Certain conditions associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).