Long ago the Menstrual period was routinely referred to as the curse, giving the unique physiological function of a woman’s body an unwanted and negative connotation. We as a community are slowly but surely breaking the taboo around this “bloody” issue in most situations but for those amongst us who suffer from pain during periods, it may still feel like a curse.
Do you suffer from pain during one or more days of your period?
Have you ever made or altered plans because of approaching periods?
Have you ever taken a day off from school or work due to periods?
Have you had anxiety about your upcoming period?
Have you ever taken pain killers for period cramps?
If the answers to any of the above questions is yes, then this might help you. Read on.
I thought period cramps are pretty normal. Doesn’t everyone have them?
Nearly 25 percent of all women and 70-90 percent of adolescent girls suffer from period cramps. Mild to moderate cramps in the lower abdomen lasting for few hours in some and maybe up to 3 days in others which are easily relieved by home remedies or mild pain killers are usually seen in young girls. The pain may begin only after a year of the beginning of menses. This is called Primary dysmenorrhea and is not generally associated with any underlying disease process.
Although this type of painful periods can be quite common, they do cause some distress in young girls. Pain during periods that starts later in life and due to underlying conditions like Adenomyosis, Fibroid uterus or Endometriosis etc is called Secondary Dysmenorrhea. Secondary dysmenorrhea can last even after the period bleeding is over.
I was told my painful periods will sort themselves out and I don’t need to seek a doctor.
In most cases of primary dysmenorrhea, that’s true. Pain during periods can reduce over a period of time and usually after childbirth. But if pain persists or increases with age it’s a reason to consult a doctor. In any case, no woman should ever need to suffer through pain for a condition that can be easily helped. Take help when you feel the need for it.
What are the other changes associated with period pain?
Many women experience bloating sensation in the abdomen, constipation before onset of period and sometimes loose stools after the onset. Mood changes, nausea, a lack of appetite, headaches and passing of clots in the menstrual discharge with heavy bleeding are some of the associated symptoms.
What are the simple precautions and remedies that can help in reducing the pain?
Simple remedies like using a hot water bag to the abdomen and back, massaging the lower abdomen gently and rest may give adequate relief. Drinking plenty of water and exercising regularly can reduce the severity of pain in a large number of women. Exercise has the additional benefit of keeping your cycles regular. Reduce the intake of junk food , too much coffee and tea, excessive salt and processed food in your diet. Avoid alcohol & smoking. Check for any mineral and vitamin deficiencies and correct them.
Why do I need tests if dysmenorrhea is so common? Can’t I just take pain killers?
Primary dysmenorrhea doesn’t really need any tests. Most of the time the decision to investigate a woman with dysmenorrhea is influenced by the pattern of pain and severity of pain. Considering the changes in today’s lifestyle even one day off from work or school may not be welcome. Not everyone can afford to take rest. Therefore, it becomes important for doctors to try and reduce a woman’s suffering. With that in mind gynaecologists tend to do detailed clinical examination some preliminary tests to rule out any underlying conditions. An ultrasound scan of the pelvis and Vaginal swabs for culture are done initially. If we find something on Ultrasound, further tests like MRI, or diagnostic Laparoscopy may be advised.
Pain that lasts for few hours on the first 3 days and not severe can be treated conservatively. But pain that appears in older women, lasting through the period and sometimes even after it and pain that seems to be increasing in intensity over many months, may be due to some underlying condition like Fibroids, Endometriosis, Infections, Uterine shape abnormalities etc. In some such cases simple painkillers may not be enough.
What are some conditions causing period pain that may need treatment other than pain killers?
Adenomyosis: A condition where the inner lining of the uterus grows into the muscle of the uterus. Typically seen in older women after child-bearing years. It causes pain during periods and during sexual intercourse too. This condition reduces after menopause. If the pain is not controlled by painkillers the only possible long term relief is by the removal of the uterus [ a hysterectomy].
Endometriosis: A condition where the cells of the inner lining of uterus are found outside the uterus, typically on the ovaries, fallopian tubes, outer surface of the uterus and intestine. This can occur at any age. It causes thick walled cysts in the ovary and a lot of pain even after the period is over. Various modes of treatment are applied based on the need for child-bearing, severity of symptoms etc. Its a progressively worsening condition hence many women end up with a need for surgery.
Fibroid uterus: A benign condition where small hard lumps of muscle cells form in the wall of the uterus. The increase in size and distortion of the shape of the uterus can cause pain and heavy bleeding during periods. Depending on symptoms and size it is treated with medications or surgery.
Pelvic inflammatory disease: This is a condition where there is infection transmitted from the vagina into the uterus and around it. It causes severe pain, fever and discomfort during urination and passing stool. Although if treated at the right time it can resolve completely, repeated infections can cause chronic long term pain.
Ovarian cysts: Fluid filled sacs occurring in the ovaries are called cysts. They may be simple cysts filled with clear fluid or endometriosis-induced cysts, filled with blood. Typically blood filled cysts cause period pain and may sometimes need extra measures other than plain painkiller medications. Large cysts need surgery.
What are the usual ways to treat period pain?
Primary dysmenorrhoea is mostly relieved by the non-medical home remedies and lifestyle changes detailed earlier. If the pain disturbs the day-to-day activities its not such a bad idea to take mild pain killers like acetaminophen [or paracetamol].
In cases of secondary dysmenorrhoea, the treatment depends on the underlying condition, the need for child-bearing, the response to medical treatment etc. Medications may include pain killers, hormonal tablets or injections, non-hormonal medications that alter periods etc. Surgery is suggested only if the conservative treatments don’t work.
Remember, there is no need to suffer the pain of menses. Seek help when you need it.