HEALTH TALK: Oh, My Menstrual Cramps

Dr. Victor Emanuel MD
Dr. Victor Emanuel MD

Dysmenorrhea, or simply dysmen, is the medical term we use to describe that dull or throbbing pain in the lower abdomen that women experience just before and during their menstrual periods.  For some women, or girls, it’s an annoying discomfort.  For others, it can be severe enough to interfere with everyday activities for a few days every month.  In fact, I dare say that dysmenorrhea contributes to a tremendous loss of productivity on a national scale every month.  Now we’re talking economics.  In many cases, it has caused many a visit to the Emergency Room, something nobody likes.

Dysmenorrhea can be primary or secondary.  The former involves no physical abnormality and usually begins within three years after you begin menstruating.  Secondary dysmenorrhea involves an underlying physical cause, such as fibroids or endometriosis.

Measures can be taken to ease the discomfort of primary dysmenorrhea.  And comfort can be taken in the fact that cramps decrease in intensity with age and often disappear after pregnancy.  Mind you, I am not sending anybody to go and get pregnant!  Treating the underlying cause is the way to deal with the cramps of secondary dysmenorrhea.  Secondary dysmen cramps, by the way, may start or return later in life, but can begin anytime after your first period.

SIGNS AND SYMPTOMS

Most women experience cramps at some time in their lives.  Mostly, they are a problem when they’re so severe that your day-to-day routine is affected.

Whether primary or secondary, signs and symptoms may include:

 

  • Throbbing or dull pain in your lower abdomen.
  • Pain that radiates (travels) to your lower back and thighs.

Less commonly, there may be:

  • Nausea
  • Loose stools
  • Nausea
  • Vomiting

 

WHAT CAUSES THE PAIN?

Well, to create a nourishing environment for a fertilized egg (future fetus), the female hormone estrogen causes your uterine lining (endometrium) to thicken every month.  Shortly after, a follicle – a tiny sac in your ovary that contains a single egg – ruptures and releases its egg (ovulation).  If the egg gets fertilized by contact with a sperm on it’s way to the uterus, the egg implants in the lining of the uterus.  However, most often the egg passes through your uterus and out your body unfertilized.  And shortly thereafter, the uterus sheds its lining, and your menstrual flow begins.  In other words, every month, your uterus prepares for a fertilized egg.  If it doesn’t get one, it sheds it’s lining, hence your period.

To expel its lining, your uterus (womb, by the way) contracts.  Prostaglandins, hormone-like substances involved in pain and inflammation, set off the muscle contractions of the womb.  It is thought that prostaglandins cause the cramps of primary dysmenorrhea.

Secondary dysmenorrhea may be caused by a number of conditions, including:

Endometriosis.  In this painful condition, the type of tissue that lines your womb becomes implanted outside of it, mostly on the fallopian tubes, ovaries or tissue lining the pelvis.  It may even get into your abdomen on the peritoneum (abdominal lining).

Pelvic Inflammatory Disease (PID).  I believe we covered this in a previous column.  Remember?  Sexually transmitted bacteria.

Use of an intra-uterine device (IUD).  Every woman who ever asked about contraception (family planning) would have been told about these, previously commonly called the coil.  They may cause increased cramping, especially during the first few months after being placed.

Uterine fibroids and polyps.  These non-cancerous growths protrude from the lining of the uterus.  They interfere with normal rhythmic uterine contractions.

ANY RISK FACTOR?

Yep.  Severe menstrual cramps are more likely if you have one or both of the following:

 

Early onset of puberty (age 11 or younger).
A family history of painful periods.  So it’s o.k. to blame mammy or aunty, for once, right?

WHEN TO SEEK MEDICAL ADVICE

If cramping disrupts your life for several days a month.
If you’re older and just started experiencing severe cramps.

SCREENING AND DIAGNOSIS

When you visit the doctor, as usual he will ask you a number of questions and he will examine you, including of course, below the waist, looking for abnormalities and any indications of infection.

To rule out other causes of your symptoms or to identify the cause of secondary dysmenorrhea, doctor may request tests such as:

Imaging tests.  These are tests done to give the doctor an image of your reproductive system without cutting or pricking you.  These may include ultra- sound scan, CT scan or MRI (magnetic resonance imaging).

Laparoscopy. Not a new word to many of you.  This is a surgical procedure whereby the doctor can look into your pelvic cavity by making tiny incisions (cuts) in your abdomen and inserting a fiber-optic tube with a small camera lens.

Hysteroscopy.  An instrument is inserted through the vagina and your cervical canal to examine the canal and the inside of the uterus.

ARE THERE COMPLICATIONS?

Secondary dysmen can be problematic depending on the cause.  If it’s PID, for instance, scarring of the tubes can lead to infertility or ectopic (wrong place) pregnancy.  Endometriosis can also lead to impaired fertility.

CAN’T WAIT FOR TREATMENT?

For secondary dysmenorrhea, the underlying cause must be treated.  For PID, you’ll need antibiotics, and you’ll need to undergo surgery to remove fibroids or polyps.  Endometriosis is usually treated with oral medication, but surgery is sometimes done as well.

Over-the-counter medications may also be helpful, from Paracetamol to Non-steroidal anti-inflammatory drugs (NSAID’S) such as Aspirin, Advil, and Aleve.  Theoretically, NSAID’S should work well because they are prostaglandin inhibitors.  Remember prostaglandins are thought to play a role in the sequence of events leading up to the cramps.  Severe cramping may prompt the doctor to recommend low-dose contraceptives to prevent ovulation, which may reduce the production of prostaglandins, and hence the severity of your cramps.

WHAT ABOUT SELF-CARE MEASURES?

For primary dysmenorrhea, try soaking in a hot bath or using a heating pad on your abdomen.  Also try to:

  • Exercise regularly.  Exercise results in an increased release of endorphins, your body’s natural painkillers.
  • Get plenty of rest.  This way, you’re less vulnerable to pain.

OTHER MEASURES

Some women find relief through massage, yoga, or meditation, all stress-relieving activities that may lessen pain and are unlikely to be harmful.  Some find acupuncture helpful for pain relief.  If it helps, if it’s legal, use it if it’s available.

See you next week.

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8 Comments

  1. April 21, 2015

    For women with fibroids who are experiencing otherwise unexplained fertility problems, the best course of action unclear. It can be difficult to determine whether the fibroids have anything to do with the difficulty getting or staying pregnant. Experts advise that you and your partner first undergo a complete infertility evaluation before you zero in on the fibroids as the root cause. Pregnancy rates for women with and without intramural fibroids are similar too, but studies suggest that the chances of the embryo implanting is about 19 percent lower in the fibroid group. If implantation occurs, however, women have similar delivery rates. However, there’s still hope for you and many other women facing this challenge.

  2. dysmenorrhea
    January 13, 2014

    Great article doc. I suffered from dysmenorrhea and menorrhagia as a child in Da. It was not until several years later, in the US was I diagnosed with moderate to severe endometriosis. I am glad that you brought up this awareness. I think it to be very beneficial. I always thought it strange that I had debilitating pain during my menses and no one else did. I thought I was a woos… But I’ve since had surgery as a treatment and undergoing a study by a drug company testing this new drug Elagolix. I am in the 2nd stage of the study and pray it helps others like myself suffering from this chronic disease.

  3. sufferer
    January 11, 2014

    doc, i have been suffering from this thing every month after i had my two children. every month is something different. the backache, the tummy cramps, the headache, nausea, vomiting, diarrhea and fatigue. there are times i even think i maybe pregnant. a friend told me use rum i helps for a while then the pain comes back. buscopan is my usual buddy around that time of month. i went to my doc n he says everything is normal so there no need for surgical interventions.

  4. rosebud
    January 11, 2014

    Very good information Doc. I suffered with this like forever and experienced al the symptoms you identified. After visiting a gynecologist he advised that a “retroverted uterus” was the cause of the problem. I underwent surgery to turn the uterus around. I never experienced that horrible pain and the other symptoms again. Maybe some other women have a similar problem.

  5. FemmeDominique
    January 10, 2014

    Thanks Doc. Yes I was told that cramps would stop after having children. Not me. It even got worse after each child and I had three. Every month was different. Whoever started this myth was special. It does not happen to everyone. It was bad at 45 as it was at 16.

  6. January 10, 2014

    Got my first at 12, had cramps from the third month until I had a hysterectomy, after 5 children. I was told that if I had boys first, the cramps would vanish, well! I had two boys first, and it never stopped. My sister had cramps at an early age, and so did my daughter’s. I.m talking about cramps that messed up school, travel etc

  7. Pebble
    January 10, 2014

    I have four children and it never
    stopped the pain so that’s a myth.

  8. Anonymous
    January 10, 2014

    :mrgreen: Well Doc mine started after my pregnancy. I never had this issue before I even use to forget that I was mensurating, thats how easy it use to be before the baby so why the reverse? Did someone with colic step on my feet?

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