Painful periods: Most women’s nightmare

There’s hardly a woman on the planet who doesn’t know the misery of period pains. Survey shows that 70 percent of young women regularly use the painkillers to cope with the pain and at least 50 percent say it seriously disrupts their lives.

Period pains medically known as the dysmenorrheal are cramping abdominal pains experienced during, and sometimes just before, a woman’s monthly period. They affect many women at some time in their lives. Usually they are not a sign of serious underlying problem and can be treated with self help methods.

There are two types namely, primary and secondary dysmenorrhoea.

Primary dysmenorrheal is the term used to describe normal period pain experienced by many women around the time of their period. There is no underlying medical problem. It most commonly affects teenagers and young women. This is the type of period pain discussed in this article.

Whilst secondary dysmenorrhoea is the term used to describe pain around the time of the period that’s caused by an underlying problem. It is less common than primary dysmenorrhoea, and tends to affect women later in their reproductive lives.

Pains may start with the first-ever period. However, they are more likely to begin 6 – 12 months later, once cycles where an egg is released are established. It’s these cycles that appear to cause more pain.

Painful periods were once thought to be entirely psychological. Because doctors could find no physical abnormality in patients, they assumed that the cause was all in the mind. Fortunately, we now know better.

Once an egg has been released from one of the ovaries, natural chemicals produced by the body called prostaglandins are made in the lining of the uterus (womb). Some prostaglandins cause the walls of the uterus to contract. Some women produce higher levels of prostaglandins, which may cause increased contractions of the uterus. These cramps may be more painful because there is reduced blood (and therefore oxygen) supply to the myometrium (muscle wall of the uterus) during the contractions.

Cramping lower abdominal pains are the most common symptom of period pain (dysmenorrhoea). Pain can also spread to the lower back and the thighs. When severe, the pain can be accompanied by nausea or vomiting, diarrhea, constipation or feeling faint. Some women may also get headaches.

The aim of these contractions is to help the womb shed its delicate lining (as a period or bleed), so a new lining can be grown ready for a fertilized egg to implant itself. This is an essential part of female fertility, but pain is a side effect.

Pain usually lasts two to three days and tends to happen in the first few days of the period, coinciding with the time of heaviest blood flow. Period pains do not cause any damage to the uterus and a pelvic examination of “internal” would show that the uterus and ovaries are normal.

Up to 15 percent of women have period pains severe enough to interfere with their daily activities. This can lead to missing days at school or work or decreased participation in social or sporting activities.

Period pains are often worse in adolescence and tend to improve as women get older. Many women notice that their periods are less painful after they have had a baby.

Over the counter painkillers such as ibuprofen and paracetamol often help. There are also painkilling tablets available that contain the drug, hyoscine (e.g. Feminax), that may help prevent the muscle contractions.

Moderate physical exercise can also be helpful for relieving pain, and may help prevent period pain. Many women find a hot water bottle held to the abdomen or back is comforting. Self-heating patches or heat packs that can be warmed in a microwave are a convenient alternative.

If these measures do not provide enough relief, or if period pains are interfering with daily life, then it’s best to see a doctor. A doctor can usually diagnose period pains easily and several treatment options may be discussed.

These work by decreasing the levels of prostaglandins. Examples include ibuprofen, naproxen and mefenamic acid. They relieve pain and can also decrease the amount of bleeding. They work best when taken regularly form the time when either pain or bleeding starts or the day before a period is due.

These drugs are not suitable for everyone – for example, people with asthma or indigestion problems may not be able to take them.

The combined oral contraceptive pill, which is the most widely used pill, prevents ovulation (the release of an egg). This may help to decrease period pains because of the lining of the uterus remains thin and fewer prostaglandins build up. It is particularly useful if a woman also wants contraception.

Mirena is the brand name of a new type of intra-uterine contraceptive device (IUCD), or coil. It differs from other coils because it releases a form of the hormone progesterone (called levonorgestrel) into the uterus. This prevents the thickening of the lining of the uterus.

In addition to providing contraception, some women find that their periods become much lighter within three to six months of having the coil fitted. In a few cases the period stops altogether. As a result of this, many women find that they also experience less period pains. Sometimes the non-hormone releasing coils can cause or increase period pains.

There is some evidence that taking thiamine (vitamin B1) or magnesium supplements can help reduce period pains.

Transcutaneous electrical nerve stimulation (TENS) is another alternative. This involves a small electrical device, which is taped to the lower back. It releases tiny electrical pulses that aim to ‘distract’ the brain from experiencing pain from the nerves supplying the uterus.

It’s most commonly used for labour pains. TENS machines are usually supplied by physiotherapists, but it’s also possible to buy or hire them from local health centres, high street chemists, hospital pain clinics or branches of the National Childbirth Trust (NCT).

Some people find that acupuncture relieves certain kinds of pain, including period pain, but there is little definite scientific evidence to prove this.

As mentioned, period pains can sometimes be the result of underlying gynecological condition (secondary dysmenorrhoea). A doctor should be consulted if period pains are particularly severe, or new, or associated with any of the following symptoms: bleeding between periods, bleeding after intercourse, pain during or after intercourse, unusually heavy periods.

A doctor will carry out a pelvic examination and may then arrange further investigations or a referral to a gynecologist. Tests might include, for example, an ultrasound scan of the pelvis to look at the uterus and ovaries.

Women and Health
Elizabeth Clorah