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Painful periods

How do you cope with aches that accompany the cycle

Savitri dreads having her periods. She gets intense pain and sometimes has to take time off from work. She wants some relief and wonders if she is the only one who suffers so much. She has discussed this problem with her friends and has found that many of them have varying levels of discomfort during their periods.

More than half of women experience some pain during their menstrual periods, at least for 1-2 days each month. Usually, the pain is mild. Sometimes, however, the pain is severe enough to keep them from their normal activities. This pain is called dysmenorrhoea. Painful periods are the leading cause of women missing work and school.

Why are periods painful?

The uterus is made up of muscle fibres and like any muscle, will contract and relax. During the periods, the lining of the uterus produces a substance called prostaglandins. These prostaglandins cause the uterus to contract. When the uterus contracts, it produces a cramping pain. As the period continues, prostaglandin levels drop. This is why pain tends to lessen after the first few days of the period.

Types of dysmenorrhoea

There are two types of dysmenorrhoea — primary and secondary.

Primary dysmenorrhoea is pelvic pain that is primarily due to the period. Women with primary dysmenorrhea may have cramps or pain in the lower abdomen or lower back and a pulling feeling in the inner thighs. If the pain is severe, there may be nausea and vomiting. Primary dysmenorrhea often begins soon after a girl begins having menstrual periods. Some cycles may be more painful than others. As a woman gets older, her periods often become less painful. Some women may experience lessening of the pain after childbirth.

Secondary dysmenorrhoea is menstrual pain that has another cause in addition to menstruation. With secondary dysmenorrhoea, pain often begins earlier in the menstrual cycle. It usually lasts longer than normal cramps. It may begin some days before the period starts, it may get worse with the period, or it may persist after the period ends.

Some of the most common causes of secondary dysmenorrhoea are:

Endometriosis: a condition in which endometrial tissue is found in other areas in the body, such as the ovaries and fallopian tubes. Endometrial tissue outside the uterus responds to monthly changes in hormones the same way it does inside the uterus. It also breaks down and bleeds and this can cause pain, especially during the period.

Fibroids: muscle tumours that form on the wall of the uterus. They are not cancerous, and they can cause pain and heavier bleeding with periods.

Pelvic inflammatory disease: an infection of the uterus, fallopian tubes, or ovaries. Most cases develop from sexually transmitted diseases.

Intrauterine device: a device placed inside the uterus to prevent pregnancy. It can cause pelvic pain and cramping and may make normal menstrual cramps worse.

Diagnosing the cause

Usually in a younger woman, not many tests will be performed. Treatment with medications will be initiated and only if there is no relief, will tests be undertaken to find any specific cause for the pain. In women who develop dysmenorrhoea after many years of fairly painless periods, tests may be done to find out if a new problem has arisen, leading to painful periods. An ultrasound scan of the pelvic organs may help in diagnosis.

In some severe cases, when other problems are suspected, the gynaecologist might suggest a laparoscopy. During laparoscopy, the gynaecologist makes a small cut near the umbilicus. A thin-lighted scope (laparoscope) is then inserted into the abdomen. The laparoscope allows the gynaecologist to view the pelvic organs.

Finding relief

Women who exercise regularly often have less menstrual pain. Aerobic exercise, such as walking, jogging, biking or swimming can be helpful. A heating pad or hot water bottle on the abdomen is soothing. Relaxation exercises like meditation and yoga can increase the ability to cope with pain.

Medications

NSAIDs (nonsteroidal anti-inflammatory drugs) are drugs that block the production of the prostaglandins that cause menstrual cramps. The commonly prescribed NSAIDs are ibuprofen, naproxen, mefenamic acid or ketorolac. NSAIDs work best when they are taken at the first sign of the period or pain. The tablets usually need to be taken for 1 to 3 days. These tablets can irritate the stomach and should not be taken on an empty stomach. Birth control pills also reduce menstrual pain and are often prescribed for controlling menstrual pain.

GITA ARJUN

(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)

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