3. Dysmenorrhoea
(Period pain)
Why dysmenorrhoea is
a problem
Dysmenorrhoea is medical term for
painful menstrual cramp of uterine origin just before the menstrual begin and
usually subsided one or two days after.
Most of the time it is physiological but it is often associated with
endometriosis and other uterine pathology.
Studies have shown the prevalence of dysmenorrhoea in female population
vary from 45%-95%. It is indeed the most common gynaecological condition in
women regardless of age and race and nationality.
Dysmenorrhoea affects
productivity due to common absenteeism from work and school. Studies have shown
almost 13% to 51% of women have been absent from work and school at least once
and 5% to 14% are often absent owing to the severity of symptoms. Yet despite this substantial effect on their
quality of life and general wellbeing, few women with dysmenorrhoea seek
treatment as many believe it would not help.
What types of dysmenorrhoea are
there?
There
are two type of dysmenorrhoea based on what the underlying cause is. Primary dysmenorrhoea is menstrual pain
without a pelvic disease, and secondary dysmenorrhoea is menstrual pain due to
identifiable disease. In primary dysmenorrhoea, menstrual cramp normally begins
6 to 12 months from the onset of the menarche (the first period) and occurs for
8 to 12 hours at the onset of menstrual flow. It is commonly accompanying by
other symptoms like back and thigh pain, headache, diarrhoea, nausea, and
vomiting. Primary dysmenorrhoea is common among the teenagers and young woman
and one of the most common reasons for school absentism. Primary dysmenorrhoea
often improves as a woman grow older and after childbirth.
Secondary
dysmenorrhoea usually arises later when a woman is in her 30s or 40s, after the
onset of an underlying pelvic disease. Other gynaecological symptoms, such as pain
during intercourse, heavy menstruation, intermenstrual bleeding, and postcoital
bleeding, may also be present depending on the underlying condition. Common
causes of secondary dysmenorrhoea include endometriosis, fibroids (myomas),
adenomyosis, endometrial polyps, pelvic inflammatory disease, and the use of an
intrauterine contraceptive device. Secondary dysmenorrhoea often gets worse
with time and the pain may become more severe in it intensity and duration and
it may severely affect productivity and quality of life if not treated.
How would your gynae doctor investigate dysmenorrhoea?
Firstly,
your gynae doctor would get a detail history of your menstruation and performed
a physical examination. Information about the onset, location, duration, and
characteristics of pain, plus any aggravating or relieving factors, would be
sought. The doctor would perform an Ultrasound of the pelvis to look for
evidence of undelying disease like
endometriosis, uterine fibroid or polyp that may cause the menstrual pain.
Treatment and remedies for
dysmenorrhoea
The aim
of treatment of dysmenorrhoea is to releive pain and treating the underlying
cause. The treatment modalities can be divided into two i.e non-hormonal drugs
and hormonal drugs.
Simple analgesics
(pain killer)
- Simple analgesics like paracetamol and aspirin may be useful for mild to
moderate menstrual pain
Non steroidal
antiinflammtory drugs (NSAIDs)
– is a good pain relief. Between 17% and 95%
of women achieve pain relief with an NSAID for moderate pain over three
to five days. However gastrointestinal effects (nausea, vomiting, and/or diarrhoea)
are of particular concern with NSAIDs.
Oral contraceptives
(OC) – there
are some evidences that showed oral contraceptives pills relief dysmenorrhoea
significantly especially those with secondary dysmenorrhoea. OC also reported
to reduce mentrual blood loss. If a
woman also wants to avoid pregnancy, then a combined oral contraceptive may
well be a worthwhile treatment option. Adverse effects such as headache,
nausea, abdominal pain, bloating, anxiety, loneliness, weight gain, and acne
have all been reported in association with combined oral contraceptives.
Levanogestrel
Releasing Intra-Uterine System (MIRENA) – MIRENA is an intrauterine
device containing levonorgestrel hormone. It release the hormone into the
uterine cavity for at least five years, thus preventing the thickening of the
lining of the uterus. It has been shown to be effective in reducing
dysmenorrhoea in women with endometriosis.
Alternative
therapies
In all, 10-20% of women with primary
dysmenorrhoea do not respond to treatment with NSAIDs or oral contraceptives.
In addition, some women have contraindications to these treatments.
Consequently, researchers have investigated many alternatives to drug
treatments.
Herbal products or medicines, and dietary supplements - Herbal and dietary therapies are
popular as they can be self administered and are available from health shops,
chemists, and supermarkets. This availability, although helpful, can create
problems with the control of dosage, quality, and drug interactions. Studies
have shown that thiamine, pyridoxine, magnesium, and fish oil may be effective
in relieving pain, although some of these may be associated with adverse
effects. Vitamin E was also shown in some study to be effective in treating
dysmenorrhoea, but it advises caution in use owing to potential adverse effects
when used in high doses.
Exercise -
Physical exercise may reduce
dysmenorrhoea. It is postulated that exercise works by improving blood flow at
the pelvic level as well as stimulating the release of β endorphins, which act
as non-specific analgesics.
Summary points
Dysmenorrhoea is a common gynaecological condition that is underdiagnosed and undertreated
Simple analgesics and non-steroidal anti-inflammatories are effective in up to 70% of women
Oral contraceptives can be considered for women who wish to avoid pregnancy
For women seeking alternative therapies heat, thiamine, magnesium, and vitamin E may be effective