If you have had normal periods and are starting to experience period pain as you are growing older, you may be having secondary dysmenorrhea. This is often related to an underlying cause such as uterine fibroids or endometriosis. It is not always possible to identify the cause of painful menstrual periods. Some people are simply at a higher risk of having painful periods.
A very large number of young women come to my OPD complaining about menstrual pain. They seem dazed and confused and find it difficult to communicate with their partners or parents while they are undergoing pain. Moreover, they are completely ignorant about the reasons behind menstrual pain.
Menstruation occurs when the uterus sheds its lining once a month. Some pain, cramping and discomfort during menstrual periods are normal. Excessive pain that causes you to miss work or school is not normal. Painful menstruation is also called dysmenorrhea. There are two types of dysmenorrhea: primary and secondary. Primary dysmenorrhea occurs in people who experience pain before and during menstruation. If you have had normal periods and are starting to experience period pain as you are growing older, you may be having secondary dysmenorrhea. This is often related to an underlying cause such as uterine fibroids or endometriosis. It is not always possible to identify the cause of painful menstrual periods. Some people are simply at a higher risk of having painful periods.
One symptom of dysmenorrhoea is pain in the lower abdomen that can spread to the lower back and legs. You could also experience pain that is acute and gripping or pain that is constant and dull (ache). Moreover you might experience pain that is an intermittent combination of both patterns (acute and gripping and constant and dull).
Typically the pain starts when the period starts, or earlier. The first 24 hours may be the most painful. Clots may be passed in the menstrual blood.
Dysmenorrhoea can be associated with headaches, nausea and vomiting, digestive problems such as diarrhoea or constipation, dizziness, premenstrual symptoms like tender breasts and a swollen abdomen (which may continue throughout the period) and pain continuing after the first 24 hours (this tends to subside after two or three days).
Some factors that predispose you to this condition are being under 20 years of age, a family history of painful periods, smoking, heavy bleeding during periods, irregular periods, no history of pregnancy and early menarche (reaching puberty before age 11)
A hormone called prostaglandin triggers muscle contractions in your uterus that expels the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins. Painful menstrual periods can also be the result of a slew of underlying medical conditions such as premenstrual syndrome or PMS. PMS is a common condition that is caused by hormonal changes in the body occurring 1 to 2 weeks before menstruation begins. Symptoms typically go away after bleeding begins. Other underlying conditions include endometriosis, which is a painful medical condition in which cells from the lining of the uterus grows in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis. Fibroids in the uterus can also cause painful periods. Fibroids are noncancerous tumors that can put pressure on the uterus or cause abnormal menstruation and pain. However fibroids generally and often do not cause any symptoms.
Pelvic inflammatory disease (PID) is yet another condition that can cause or aggravate menstrual pain. PID is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that causes inflammation of the reproductive organs and pain. Then there is Adenomyosis, which is a rare condition in which the uterine lining grows into the muscular wall of the uterus, causing inflammation, pressure, and pain. It can also cause longer or heavier periods. Lastly painful periods can also be attributed to cervical stenosis, which is a rare condition in which the cervix is so small or narrow that it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain.
Simple home treatments can be immensely helpful in relieving period pain. Using a heating pad on your pelvic area or back, massaging your abdomen, taking a warm bath, doing regular physical exercises, eating light and nutritious meals and practicing relaxation techniques or yoga are some recommended remedies.
Taking anti-inflammatory medications such as ibuprofen several days before you expect your period can also help. Taking vitamins and supplements such as Vitamin B -6, Vitamin B-1, Vitamin E, Omega-3 fatty acids, calcium and magnesium can help too. Raising your legs or lying with your knees bent and reducing your intake of salt, alcohol, caffeine and sugar to prevent bloating are recommended for pain management.
If menstrual pain is interfering with your ability to perform basic tasks each month, it may be time to talk to a gynecologist. Sudden cramping or pelvic pain could be signs of an infection. An untreated infection can cause scar tissue that damages the pelvic organs and may lead to infertility. If you have symptoms of an infection, such as fever, severe pelvic pain and foul smelling vaginal discharge it is advised to take immediate medical attention.
By Dr Rajashree Sharma
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