HEALTH TALK: Oh, my menstrual cramps

INTRODUCTION

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 and vomiting
Loose stools
Sweating
Dizziness

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.