Understanding Menstrual Pain

Menstrual pain affects over 25 per cent of women

By Dr. Goke Akinrogunde

Sometimes, menstrual pain is used synonymously with menstrual cramps, but the latter may also refer to menstrual uterine contractions, which are generally of higher strength, duration and frequency than in the rest of the menstrual cycle.

    Menstrual pain, which is medically described as dysmenorrhoea is a female medical condition of pain during menstruation that interferes with daily activities.

   The pain of dysmenorrhea can come in different modes, including sharp, throbbing, dull, nauseating, burning, or shooting pain. It may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Sometimes, menstrual pain exists with excessively heavy blood loss during menses, especially in symptomatic fibroid cases.

Types of menstrual pain Secondary dysmenorrhea

The term secondary dysmenorrhea isused when symptoms are attributable to an underlying disease,disorder, or structural abnormality either within or outside the womb (uterus). Secondary dysmenorrhea is diagnosed when menstrual cramps are caused by other conditions such as endometriosis, fibroid tumors, pelvic adhesions, and ovarian cysts or by the use of an interuterine device (IUD) for birth control. Usual appropriate treatment of the implicated ailment (where this is possible) would normally result to anend of the menstrual pain in the victim.

Primary dysmenorrhea

On the other hand, the term primary dysmenorrhea is used when none of the aforementioned is detected.Some research findings indicated that dysmenorrhea occur approximately in 25% of women, this is probably an under-estimation. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reported cases usually declining with age. The prevalence in adolescent females has been reported to be between 67.2 per cent and 90 per cent.It has been generally noted that childbearing relieves menstrual pain, although this does not always occur.Signs and symptoms

The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the navel region or at the lower region of the abdomen. It isalso commonly felt in the right or left abdomen and the pain can also radiate to the thighs and lower back.In some cases, symptoms often co-occurring with menstrual pain include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smelland touch, fainting, fatigue and general irritability.

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Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation.

Hence, in some cases, the use of certain types of birth control pills prevents the symptoms of dysmenorrhea, because the birth control pills stop ovulation from taking place.

Causes

Generally in all women in their reproductive age, during a woman’s menstrual cycle, the innermost liningof the womb (endometrium) thickensin preparation for potential pregnancy.

After ovulation, if the ovum is not fertilized and there is no pregnancy, the endometrium built-uputerine tissue is thus not needed andthus shed as the menses.Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents. Release of prostaglandins and other inflammatory mediators in the uteruscause the uterus to contract.

These substances are thought to be a major factor in primary menstrual pain. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina.

These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or “cramps” experienced during menstruation.

Controlling menstrual pain; HormonalcontraceptivesAs noted above, the use of hormonal contraception can improve or relieve symptoms of primary dysmenorrhea, especially the more potent long acting ones like Norplant (usually buried under the skin and lasting fiveyears plus) and injectable Depo-provera (lasting some three months).As noted above, menstrual cramps are thought to be related to the naturally occurring prostaglandin, which causes the uterus to contract. If a woman does not ovulate, it is unlikely that she will encounter cramps during her period. For this reason, physicians often prescribe oral contraceptives to ease painful periods. However, it should noted that birth control pills cause abnormal bleeding in some women.

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