The term ‘Dysmenorrhoea’ refers to painful periods or menstruation. There are two types of dysmenorrhoea namely; Primary dysmenorrhoea and Secondary dysmenorrhoea.
In ‘primary dysmenorrhoea’, the pain is not caused by any underlying abnormality. However, in the case of ‘secondary dysmenorrhoea’, the pain is generally caused by a specific gynaecological disorder. According to statistics, around 50 per cent of women tend to suffer from primary dysmenorrhoea while a quarter of women usually suffer from secondary dysmenorrhoea.
Primary dysmenorrhoea often begins during adolescence. Secondary dysmenorrhoea is commonly found in women over 25.
In primary dysmenorrhoea, the uterus muscles tend to contract harder than usual to dislodge the endometrium during menstruation. These contractions significantly reduce the flow of blood to the uterus, thus making the pain even worse.
Symptoms of Primary Dysmenorrhoea
- Pain in the lower abdomen which spreads to the lower back region and legs
- Gripping pain or constant ache
- The pain begins on or before the periods
- The pain becomes severe in the first 24 hours
- Clots in the menstrual blood.
- Nausea and vomiting
- Diarrhoea or constipation
- Tender breasts and swollen abdomen
- Pain continues after the first 24 hours and subsides after two or three days
Causes for Primary Dysmenorrhoea
In primary dysmenorrhoea, the uterus contracts too hard to dislodge its thickened lining or the endometrium. The contractions and reduced flow of blood or ‘ischaemia’ causes tremendous pain. Primary dysmenorrhea is caused due to the production of prostaglandins. Women suffering from dysmenorrhoea usually have increased levels of prostaglandins, which results in severe contractions of the uterus than normal.
Treatment for Primary Dysmenorrhoea
Treatment options may include:
- Taking sufficient bed rest during the first day of the period
- Applying heat or hot water bottle to the abdomen to reduce pain
- Consuming pain-killers such as paracetamol
- Consuming drugs such as ibuprofen or anti-inflammatory medications that inhibit the excessive production of prostaglandins.
- Doing regular exercise
- Relaxation techniques
- The oral combined contraceptive pill, which reduces pain during periods.
In secondary dysmenorrhoea, intense pain during periods is caused by certain reproductive disorders, such as endometriosis or fibroids.
Causes for Secondary Dysmenorrhoea
In Endometriosis, the cells which line the uterus move to other regions of the pelvis, resulting in severe pain during periods.
In Fibroids, benign tumours composed of muscle and tissue develop inside the uterus and are affected by the sex hormone, Oestrogen.
Treatment for Secondary Dysmenorrhoea
Treatment may include:
- Anti-inflammatory drugs or the oral combined contraceptive pill.
- Surgery for the treatment of fibroids or endometriosis.
Pain during periods is usually treated using Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) NSAIDs such as Mefenamic acid and Naproxen must be used only up on prescription by a doctor.
Anticholinergic drugs help to relax the muscles of the womb and may be prescribed if the pain is extremely spasmodic. The combined oral contraceptive pill will generally minimize the pain associated with primary dysmenorrhoea. However, it is not suitable for all women.