DYSMENORRHEA (PERIOD PAINS)

By Dr. L. S. Lien
Mt Elizabeth Medical Centre

What is dysmenorrhoea?

One of characteristic features of adolescence is the maturity of the sexual organs.

In girls, maturity of the ovaries leads to menstruation, the monthly menstrual flow of blood and some uterine tissues. This is due to the production of hormone acting on the uterus. Though it is a normal phenomenon to have a menstrual period, the flow may sometimes be associated with pain. That is termed dysmenorrhoea.

What are the causes?

Dysmenorrhoea is pain in the lower abdomen caused by uterine cramps during the menstrual period. It is classified into 'primary dysmenorrhoea' when no abnormality causing it is identified and 'secondary dysmenorrhoea' when diseases are the cause of pain.

Primary dysmenorrhoea is common. It is one of the commonest gynaecological complaints, experienced to some degree by 50% of the females. In about 5-15% of the girls and women affected, it is severe enough to interfere with everyday activities and may result in absence from school or work. It tends to start during adolescence and to become less severe with age, and occurs in a cycle where ovulation (production of egg) is present.

The pain is thought to result from contractions of the uterus that are produced when the blood supply to the lining (endometrium) is reduced.

Sometimes an underlying disorder like endometriosis (menstrual blood in the pelvis), growth, inflammation, and other abnormalities, may result in dysmenorrhoea.

How is it like?

The lower abdominal pain of dysmenorrhoea may extend to the lower back or to the thighs. It may present as cramps that come and go or a dull ache that is constant. Generally the pain begins with or shortly before the menstrual flow, peaks after 24 hours and subsides after two days.

How is it diagnosed?

In a typical teenage girl, the diagnosis of primary dysmenorrhoea may be made without any investigations being necessary or perhaps a simple abdominal ultrasound scan can be carried out. In the case of the older woman, especially someone who has not suffered previously from painful periods, further investigation to find out the cause is necessary. This may even involve a surgical procedure like using an instrument called a scope to look inside the abdomen, at the uterus the fallopian tubes and ovaries to find out the reason.

Treatment

Historically, dysmenorrhoea was viewed unsympathetically and treated with a range of remedies that may have done little more than diverting the pain, like cold showers, low salt diets, pelvic exercises.

With the better understanding of the pain, the current treatment strategies include:

1. Self-care action plan
   Getting enough rest and sleep and exercising regularly may help reduce symptoms.
   
   
2. Medicine
   The pain can usually be reduced with anti-inflammatory drugs. Such drugs are most effective when started two days before a menstrual period is due and continued for the first one or two days of the period till the cramps subside. If the pain continues to interfere with normal activity, you should see the doctor who may suggest suppressing ovulation with oral contraceptive medication.
   
   
3. Surgery
   This is seldom needed in young girls. In older women, if the dysmenorrhoea is caused by a narrow womb opening (cervix), this may be widened surgically. If necessary, using a scope to treat the underlying condition may help.
   
   
4. Complementary treatment
   As dysmenorrhoea is made worse by stress, you may find that any relaxation technique may improve your symptoms. Breathing exercises, help to control stressful situations. Some people have found that their symptoms have been improved by hypnosis or by acupuncture.
   
   

What is the outcome of dysmenorrhoea?

Dysmenorrhoea is a common condition which is not harmful and is usually easily managed. As the adolescent grows older, primary dysmenorrhoea tends to become less severe. If you have secondary dysmenorrhoea then the outcome depends on the underlying cause.
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