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Pain During Menstruation
This is a very common problem among women. Dysmenorrhea is the medical term for pain during menstruation. Painful periods may be caused by a number of reasons. Symptoms include lower abdominal cramping, vomiting, nausea, backache and headache during menstruation.
One type of painful menstruation, called primary dysmenorrheal, tends to affect young women fairly soon after they begin to menstruate. Painful contractions occur as the uterine walls release natural substances called prostaglandins. Primary dysmenorrhea can be treated with ibuprofen (Advil, Nuprin, others) or aspirin. Exercise, good nutrition, and reducing stress are also important.
Secondary dysmenorrhea develops after years of menstruation and results from disease of the uterus, fallopian tubes, or ovaries. Among the possible causes are tumors and other abnormal growths, pelvic infection, uterine cancer, and endometriosis. Endometriosis is a serious disease that may cause infertility.
When to see a doctor
Always consult your doctor when :
- Menstrual pain is so severe that it disrupts your daily life
- Menstrual periods are so painful that they always hurt
- Over-the-counter medications do not provide relief
- Unexplained symptoms accompanied by painful periods
- If your period is delayed than expected and you are bleeding heavily
- If your period is a few weeks later than expected and you have severe pain on one side
Diagnosis
When seeking medical attention, patients who report cyclic pain during menstruation may sometimes have other diseases such as appendicitis, ectopic pregnancy and ovarian cysts, which have to be differentiated from dysmenorrhoea. Another possible misdiagnosis can occur when patients are thought to have primary dysmenorrhoea while they actually suffer from secondary dysmenorrhoea.
Primary or secondary dysmenorrhoea can only be diagnosed after a thorough physical examination, which includes a gynaecological exam. If the patient is a virgin, digital palpation will be replaced by rectal examination.
When you see your doctor, he/she will ask you about your periods and the timing and severity of the pain. The doctor may also do a pelvic exam. Since treatment for secondary dysmenorrhea depends on its cause, he/she may do additional tests.
Other diagnostic tests may include:
- Abdominal or transvaginal ultrasound scan of the pelvic organs
- Hysteroscopy with or without dilatation of the cervix
- Laparoscopy (looking into the abdomen with a similar endoscope)
- Blood tests and cultures (to rule out sexually transmitted diseases)
How is it treated?
Home remedies
Treatment for primary dysmenorrhoea focuses on relief of the pain. Women who suffer from primary dysmenorrhoea are advised to relieve menstrual cramps with the following home remedies:
- A diet with increased intake of magnesium, calcium, vitamin B-1 and omega-3 fatty acid such as fish and fish-oil
- Heat with a warm bath or a hot water bottle, applied to the lower abdomen
- Relaxation techniques done by deep breathing and light abdominal massage with stroking fingers
- Exercise, such as waist-bending, pelvic rock exercises and walking
- Drinking warm beverages may be helpful
Medication
Whether or not to use medication and what type of treatment to be administered is best decided by a doctor who will diagnose and differentiate between primary and secondary dysmenorrhoea. For primary dysmenorrhoea, the following drugsmay be helpful:
- Several non-steroidal anti-inflammatory drugs are beneficial in the management of menstrual cramps. Such as: mefenamic acid (PonstanŽ), naproxen (NaprosynŽ), and ibuprofen (NurofenŽ IbumedŽ).
- Aspirin, is not recommended.
- Oral contraceptives (OCs) are up to 90% effective for treating primary dysmenorrhoea. For secondary dysmenorrhoea, medication is aimed at the underlying disease:
- For pelvic inflammatory disease, antibiotics will be prescribed.
- For endometriosis, a number of drugs are available including NSAIDs.
Surgery
This may be necessary in women who cannot obtain adequate relief or control and is especially required in secondary dysmenorrhoea to remove endometriotic cysts, polyps, adhesions and fibroids. A hysterectomy may be required in cases of advanced endometriosis or large fibroids.
Another type of surgery, called presacral neurectomy or laparoscopic uterosacral nerve ablation (LUNA), meaning the cutting of the nerves which run in the uterosacral ligaments . These operations are very rarely performed and only in patients with severe dysmenorrhoea who do not respond to other medical treatments.