Many pop pain relieving pills and slug through the day with pain-stricken expressions. Many are just confined to their room and attempt to live with it without knowing the underlying causes. But sometimes if the causes of the pain are secondary, it can lead to more health woes than expected.[break]
“Menstrual pain known as dysmenorrhea affects many women. We classify the cases of dysmenorrhea as primary and secondary, but if the causes are secondary, it can cause more severe and prolonged menstrual pain,” says Dr Jyotshna Sharma, gynecologist and lecturer at the Department of OBS & Gynae at Kathmandu Medical College.
Keshab Thoker
The symptom of dysmenorrhea is spasmodic pain felt in the lower abdomen, along with nausea, diarrhea or constipation, headache, dizziness, disorientation and even fainting. But there is neither definite cause nor a single pathology that explains the reason behind dysmenorrhea. “The secondary cause of dysmenorrhea can be due to gynecologic disorder like Endometriosis that causes severe and recurring pelvic pain,” she explains.
There are many women who suffer from such pains without getting diagnosed. When she has her monthly periods, Sarita Aryal, 24, who works at a finance company, shuts herself inside her room and stays motionless. She feels bloated, tired and suffers an intense and unbearable lower abdominal pain that subsides only after she takes two painkillers.
A case of severe pain like that experienced by Sarita needs to be reported as early as possible as it can even be the cause of both primary and secondary dysmenorrhea.
During a woman’s menstrual cycle, the ovary produces hormones that cause thickening of uterine lining. “If a fertilized egg doesn’t get entrenched, these extra cells slough off that causes monthly periods. In a woman with endometriosis, the uterine lining cells grow outside the uterus and may implant on the ovaries, bladder or even lining of the pelvis. So those transplanted cells do not slough off each month and may bleed and cause discomfort in the body,” explains Dr Sharma.
Most of the other secondary causes are related to gynecological issues such as ovarian cyst or tumor that causes dull aching pain within the abdomen or pelvis. Those women who have Polycystic ovarian diseases (PCOS) may not only have irregular periods but may also face abdominal pain which also affects her heart and her ability to have children as well.
“Uterine fibroids can also cause inflammation on the uterus, which can lead to painful menstrual cramping. So if dysmenorrhea occurs due to secondary causes, they have to be taken seriously unlike primary dysmenorrhea,” says Dr Sharma.
The cases and stages of dysmenorrhea also differ according to age. People in younger age suffer from lesser menstrual cramps while women who go through the middle phase of their reproductive life experience more intense pain which can subside in their older ages. Some people even go through Premenstrual Syndrome (PMS) like irritability, headaches, anxiety and mood swings.
For Shruti Dhungel, 25, the period cramps occur usually on the first or the second day. “I feel pain on my back as well as my legs. So I can’t do without using hot water bags. I also suffer from excessive bleeding, so I just rest the whole day, and if I have to work then I take pain reliever like Midol,” she says.
When she consulted with a doctor, she was advised not to take medicines as the pain is supposed to gradually lessen with time. “But I think it is like we are slowly getting used to experiencing pain during that period of the month so we need to stay prepared,” says Shruti, who works as Finance and Compliance Associate for Hariyo Ban Program of WWF in Pokhara.
Dr Sharma mentions that there are lots of different cases of young girls who are diagnosed with dysmenorrhea. “People these days are more aware and have knowledge about period cramps which is why they seek treatment. Some cases relate to severe pain while some even need pain relieving injections as their cases are very critical,” she says.
Women suffering through this condition during their reproductive age may also experience heavy periods and chronic pelvic pain for a month, prior to periods or even after periods stop. But in general, most of the cases of dysmenorrhea are related to release of molecular compounds called prostaglandins and different hormones that cause muscles of uterus to contract.
Like Shruti, 22-year-old Surakshya Pradhan also suffers from menstrual cramps. But she goes to the extreme of having three or sometimes more painkillers to subside her pain. “I cannot bear the pain so I prefer to be on the safe side so I take the pills before the pain starts,” she says.
But Dr Sharma says that like every medicine has its own side effects, the main side effect of pain killers like Ibuprofen taken to reduce menstrual cramps is gastritis. Medicines like Mefenamic acid are also given to the patients not only to reduce pain but also to lower excessive bleeding.
The signs of dysmenorrhea also differ among young and old people. Dr Sharma mentions that these days girls from as early as ten years are also starting to get their first periods. “We call that anovulatory cycle in which periods occur before the formation of eggs. It can be due to use of too much artificial and preservative found in junk food. Girls that age may suffer from excessive and prolonged blood loss but may not have periods every month. But the pain might not be that severe.”
Dysmenorrhea occurs when ovulation takes place and causes major menstrual pain starting from 18 to 19 years of age till they reach 35. In the older age, ovary stops its normal function and female eggs slowly reduce and they might feel lesser pain but may suffer from prolonged bleeding.
Dr Sharma mentions that the good thing about dysmenorrhea is that it is the sign that the patient is ovulating. “So those who have periods without formation of eggs don’t suffer from period pains. It is also because they release less prostaglandin. So the pain means that there is enough prostaglandin and ovulation,” she says.
However, she mentions that it is necessary to be aware about conditions like dysmenorrhea as it has no permanent cure. “It is a positive thing that most people these days know about it since they have open communication with their friends, mother, siblings which is why many visit the clinic as well.”
Prevention is always better so maintaining a healthy lifestyle and regular exercise can reduce the problems to some extent. As long as it is a case of primary dysmenorrhea, it won’t cause many problems. But if you suffer from extreme menstrual cramps, you need to get diagnosed as it can lead to critical health problems. “Other than that, when you have menstrual cramps, use hot water bags and rest a lot and take medicines only as the last resort,” suggests Dr Sharma.
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