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PERIOD PAINS - DYSMENORRHEA

What are Period Pains ?

The pain associated with periods follows one of two main patterns. The pain may start to build up a few days before the period, and then improves when bleeding starts. It is a deep, dragging, dull and constant pain, and is called "congestive". The pain may, however, start at the onset of bleeding, and come in waves like colic. It usually gets a lot better after 2 or 3 days. This is called "spasmodic" pain.

How do Period Pains occur ?

Period pains may be a problem from the moment a woman starts to have periods or may only start later in life. They are typically either a cramp-like, congestive sort of pain or a spasmodic, colicky pain. The congestive pain is thought to be caused by changes in the womb muscle or the blood vessels around it related to hormone changes. The spasmodic pain (or clot colic) is caused by the muscles of the womb contracting to expel the blood. The blood normally clots in the womb, then dissolves and is shed in liquid form. It is not possible to explain all cases of painful periods. It is known that painful periods are much commoner in women who ovulate normally. Painful periods do not necessarily mean there is anything wrong.

Why do Period Pains occur ?

Pain at the time of the period may be a symptom of conditions such as pelvic inflammatory disease, fibroids or endometriosis. This is more likely if the symptoms develop only later in life than if a woman has always had painful periods. The contraceptive coil (IUCD) may cause periods to be more painful. More often there will be no obvious abnormality. The exact cause for period pains in these cases is not known but may be related to higher levels of hormones called prostaglandins within the womb. Spasmodic pain may also occur in women who lose more blood than normal. This may mean that all the clots in the womb are not dissolved. It then has to contract more to expel the blood and some escapes in clotted form. Women who have a large womb are likely to bleed excessively. A lot of previous pregnancies, fibroids and adenomyosis (endometriosis in the muscle of the womb wall) may enlarge the womb.

Treatment Involved for Period Pains

First of all the doctor will want to ensure that there is no abnormal cause for pain. Usually an internal examination is enough. Occasionally in severe cases that have started later in life a laparoscopy (telescopic examination through the navel) or dilation and curettage (D & C) may be suggested. This excludes endometriosis, pelvic inflammatory disease (salpingitis) and any small polyp in the womb causing more uterine contractions during menstruation. Neither of these procedures will cure the pain but it often helps to know there is no serious cause. It also sometimes helps to know why the pain is happening. If a cause for the pain was found, such as endometriosis, specific treatment will be necessary. Usually, no such specific cause will be found. The doctor might then suggest one of the aspirin-related anti-inflammatory drugs also used in arthritis. There are many of these. Some, like ibuprofen are available without prescription. Another called mefenamic acid (Ponstan) is often recommended because it also reduces the amount of blood loss at the time of the period. The best time to start painkillers is before the pain gets too severe. Anticipate it if possible.

An alternative (if the woman is not trying to conceive) is to use the contraceptive pill. This is so effective as a treatment in some women that it may even be used where there is no need for contraception. Stopping ovulation does seem to help very much. Other hormone treatments such as those used in endometriosis (Danazol, progestogens) may be tried if treatment with painkillers or the pill are unsuccessful. These tend to have more side-effects however. It is also known that pain improves very much after having a baby. Obviously these treatments may not be appropriate for everyone. A D & C has been tried to improve pain. It is no longer used, as the pain comes back after two or three periods. It is still useful to help make a diagnosis. Surgical treatments that destroy some of the nerve fibres that supply the womb have been used but their long-term benefit is unproven. In extreme cases, where the family is completed or definitely not wanted, a hysterectomy can be done. Very careful thought should be given to this if it is contemplated.

During Treatment for Period Pains

Anti-inflammatory painkillers can irritate the stomach which may cause indigestion or bleeding into the gut. Even if taking the contraceptive pill gives little relief, you can at least make periods come less often. This is done by taking two or three packets without stopping. This way you have a period only every 2 or 3 months. This should not be done without consulting the doctor. Whatever treatment has been decided should be tried for only three courses. If there is no improvement at all, alternative treatment or further investigation for an underlying cause should be considered.

After Treatment for Period Pains

Painkillers do not usually cure completely, but they can make a very difficult time more bearable. Recurrence of pain suggests in women diagnosed as having endometriosis suggests that it has come back. Sometimes it is worth thinking of complementary (alternative) medicine such as hypnotherapy or acupuncture.

If Period Pains are Left Untreated

Women who have endometriosis or pelvic inflammatory disease might be less fertile. If there is no abnormal cause having no treatment will not lead to any long-term harm and the pain will eventually stop at the menopause.

Effects on Family of Period Pains

Some women are incapacitated for 24 hours or so. Self-confidence can be very damaged by constant days missed from work or school. Family, doctors and especially employers need to be understanding of the problem.