Are You Struggling with Painful Periods?

The onset of menstrual cycle marks a major milestone in a girl’s life. It heralds her entry into womanhood & brings with it a whole new spectrum of physical, emotional & physiological changes, many of which are joyful & exciting, but some others may not be so welcome. One such unwelcome change is the onset of pain & other unpleasant symptoms during menstruation.

Menstrual cramps or a painful period is referred to as “Dysmenorrhea” in medical terms. In some cases, the pain is very mild and bearable, whereas some other women may face a lot of difficulty, so much so that they aren’t able to carry out their normal daily activities.

Research studies claim that Dysmenorrhea affects about 60-85% of girls irrespective of their economic status, country, or level of education. About 20% of girls report an absence from schools on account of dysmenorrhoea & at least 40% claim to have suffered a negative impact on their performance or concentration level due to dysmenorrhea. For working women, it negatively impacts the workplace performance and also causes psychological, physical, behavioural & social distress.

Types of Dysmenorrhea

Primary Dysmenorrhoea refers to pain & discomfort experienced during periods in the absence of a pelvic pathology or disease. It usually begins just prior to or with the onset of the menstrual blood flow & lasts no more than 2-3 days. The pain is caused by a chemical substance called prostaglandins that starts to rise just a few days before your period and causes the muscles of the uterus to contract. Prostaglandin levels are at the peak on the first day of your period and begin to drop after 2-3 days which eventually reduces the pain.

Secondary Dysmenorrhea is caused due to pelvic pathology or a disorder in the reproductive organs. In most cases, the pain may start a few days before the actual period and worsen during the periods. The pain might not completely go away even after the period ends.

What are the symptoms of Dysmenorrhea?

Ever faced a situation where you were all excited and jumping to visit your friend or a party, but your excitement got dampened by the onset of your period? Well, you’re not alone and many girls face some of the other undesirable symptoms to a lesser or greater extent during their periods. These symptoms may vary from one girl to another but usually comprise of:

• Abdominal pain.
• Nausea.
• Vomiting.
• Dizziness.
• Headache.

Diarrhoea.
Back pain.
Pain in the inner thighs.
Pain in your vagina.

What are the causes of dysmenorrhea?

Menstrual cramps happen when a chemical substance called prostaglandin rises in your body. Prostaglandins are hormone-like substances produced locally by the uterus which act on the pelvic organs. They make the uterus contract to push out the blood & menstrual discharge during periods. When the uterus contracts, it compresses the blood vessels of the uterine muscle and thus intermittently cuts off the oxygen supply to the muscle tissue. This ischemia causes pain accompanied by various other symptoms. The Prostaglandins are also responsible for the diarrhoea by accelerating gut motility. They cause cramps and other symptoms by activating the inflammatory & pain pathways of the body.

In cases of Primary dysmenorrhoea, the pain may last for 12 to 72 hours, along with other symptoms, like nausea and vomiting, fatigue, and even diarrhoea. Menstrual cramps of Primary dysmenorrhea may become less painful as you get older and may even stop entirely after you have a baby.

The causes of Secondary dysmenorrhea are related to pelvic organ dysfunction & pathology and may appear a few days before your period starts and may persist throughout the duration of the period. These may appear at different stages of life depending upon the cause.

What reproductive organ disorders can lead to dysmenorrhea?

There are various pathological reasons that cause dysmenorrhea.

• Pelvic Inflammatory Disease: Any infection of the uterus, fallopian tubes, ovaries, vagina, or other pelvic organs can lead to pelvic pain & discomfort during periods. These infections are usually acquired through unhygienic practices, sexual activity, or a low level of immunity against diseases.
• Endometriosis: This is one of the most common reasons of painful periods. Endometriosis is a condition in which the cells similar to the Endometrium, ie the lining of the uterus, also appear at other parts of the body like in fallopian tubes, ovaries, pelvic floor, urinary bladder, rectum, or other places in the body. These cells respond to ovarian hormones in a manner similar to the uterine lining and they bleed every month. Since this bleeding has no outlet from the body, the blood collects in the tissues & eventually dries off leading to formation of scars & fibrous tissues which get pulled & stretched during periods. It is this pulling & stretching which causes perimenstrual pain in women with Endometriosis.
• Adenomyosis: In this condition, the bleeding happens in the Endometrium-like cells located within the wall of the uterus thus stretching the muscles & the tissues of the uterine wall and causing pain.

Both Endometriosis and Adenomyosis are progressively debilitating conditions that can affect women. They can cause painful periods, chronic pelvic pain, infertility, and painful sexual activity. Hence, it is recommended to seek professional help from your doctor if you experience such symptoms.

• Uterine Fibroids: These are known as Myomas or Leiomyomas in medical terms. Fibroids are non-cancerous growths of the muscular cells of the uterus. They can cause heavy bleeding and pain.
• Cervical stenosis: In some women, the opening of the uterus i.e the cervix, is too small & it hampers smooth blood flow during the periods. Hence the uterus has to contract more strongly in order to squeeze out the menstrual flow through the cervical canal into the vagina from where it is finally expelled out. This excessively strong contraction of the uterus causes pain during periods.

Factors that predispose to dysmenorrhea:

There are a number of factors that may affect your chances of having a painful period. Some factors increase while others decrease the likelihood of dysmenorrhea in women. The following factors may increase your probability of having painful periods:

• The age at menarche- Menarche is the first onset of menstruation in a young girl. If the periods start at an early age, it increases your chances of dysmenorrhea.
• Increased menstrual bleeding- Heavy menstrual bleeding may be due to a pelvic organ disease that may also cause dysmenorrhea.
• Alcohol and tobacco use – these alter the chemical environment & also the blood flow in the pelvic organs, thus contributing to dysmenorrhea.
• Socioeconomic status- A low socioeconomic status maybe associated with nutritional deficiencies & contribute to dysmenorrhea.
• Obesity- Some studies claim an association between obesity & painful periods, while others have failed to find an association between the two.
• Depression.

Childbirth decreases the likelihood of dysmenorrhea because of the reduced number of adrenergic receptors in the uterus. The severity & incidence of dysmenorrhea has also been found to decrease with age. It is more common in adolescents while the incidence decreases in women over 24 years.

Tests that can be done to find out the cause of Dysmenorrhea

Whether your symptoms are minor or severe, if they are negatively affecting your performance or decreasing your productivity during periods, it is best to consult a gynaecologist who can thoroughly evaluate the reasons for the symptoms & can advise you regarding how they can be managed.

• Physical examination: Your gynaecologist would take a detailed history regarding your symptoms, their severity, timing of onset & any relieving factors before proceeding further. A physical examination would include a check-up of the abdomen, genital & pelvic structures which may or may not be aided by certain instruments as needed. There is never any need to fear these genital examinations as they are done very gently without causing any harm to you. The complete evaluation helps your doctor to find out if there is any infection or mass which may be leading to your painful periods.
• Ultrasound: An Ultrasound test uses sound waves to create an image of the uterus, cervix, fallopian tubes, and ovaries. It helps in finding out if there are any abnormalities, fibroids, cysts or other pathologies that can cause the pain.
• Imaging tests
  MRI- Magnetic resonance imaging test can show the inside & surrounding tissues of your uterus in detail to check the presence of fibroids, cysts, any other masses or any gynaecological problems.
  
  CT Scan- It combines a series of X-ray images taken from different angles around your body and uses computer processing to create cross-sectional images (slices) of the bones, blood vessels and soft tissues inside your body. CT scan images provide more-detailed information than plain X-rays do.
  
  Laparoscopy: A laparoscopy is usually done to detect & treat conditions such as endometriosis, adenomyosis, uterine fibroids, ovarian cysts etc. During this procedure, a small incision is made in the abdominal wall and a laparoscope (a fibre-optic instrument with a camera lens) is inserted to view the abdominal cavity and reproductive organs from inside. This is done under general anaesthesia.

Lifestyle changes and home remedies to manage painful periods:

Whatever be the cause of your painful periods, there is always a treatment or management option available to deal with the pain & other symptoms. You can discuss with your doctor regarding various treatment options and can also try some natural methods to deal with the symptoms.

• Use heat pads or towels over lower abdomen to relieve pain.
• Regular exercise throughout the month helps tone up your muscles so that they are able to deal with the stress of menstruation more effectively & the pain is lesser.
• Acupuncture: Acupressure therapy under an experienced practitioner is helpful in many cases.
• Reduce Stress in your daily life by doing better time management, meditation, delegating responsibility where you can, so that you are able to maintain a more relaxed state of mind.
• Meditation/Yoga.
• Avoid processed food as they contain various chemicals & xenoestrogens that can cause various harmful effects in the body.
• Curtail your caffeine intake.
• Warm bath – also helps in soothing the muscles & decreases pain.
• Dietary supplements like Calcium & Vitamin D help to build stronger muscles & bones that help to deal with the pain better.
• Herbal medicine.
• Physical/nerve stimulation therapy.
• Proper sleep.
• Eat healthily.
• Don’t smoke.
• Try a few herbal teas.

To know more about how to treat dysmenorrhea, check out our detailed article on Home remedies to relieve painful periods.

When should you consult your gynaecologist?

Some women are able to handle the period pain with home remedies. In case you are someone who does not find any relief after trying home remedies and are heavily dependent on medicines during the course of your menstrual cycle, it is better to meet with your doctor. If your period pain disrupts your daily schedule, wherein you are unable to carry out your day-to-day activities, you should consider meeting your doctor. This can help you to check if there are any gynaecological problems. Your doctor might start the course of treatment by prescribing medicines. In case there is no relief in spite of taking medicines, your gynaecologist may recommend you to take a pelvic exam.

What is the treatment for dysmenorrhea?

According to the diagnosis, your doctor will start the course of treatment.

• Pain relievers: Over the counter pain relievers or NSAID’s (Non-steroidal Anti-inflammatory drugs) are usually prescribed to treat painful periods. Ibuprofen and Naproxen Sodium help to reduce the prostaglandins levels which lessens the severity of cramps and other symptoms.
• Birth Control pills: Oral birth control or contraceptives contain hormones like estrogen and progestin that control the severity of cramps. These birth control methods can be delivered with the help of skin patches, vaginal rings, injections, oral tablets etc.
• Intrauterine Device (IUD): An IUD is a small device that is inserted and left inside the uterus to prevent pregnancy. It can be copper based or a hormonal IUD.
• Surgery: In cases where the pain is due to fibroids and endometriosis, treating the condition surgically can be helpful. In some cases, removal of the uterus is also an option if you are not planning to have children.

To summarise, periods are a part of the reproductive cycle of a woman and are an essential component of the potential of Motherhood that is an exclusive privilege of women. However, the capacity to procreate does not necessarily have to be accompanied by a monthly pain or discomfort that might hamper your daily activities & productivity. Do not hesitate to seek help & relieve your symptoms at any stage of life. Help is here, just reach out for it.