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Dysmenorrhoea

 


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Condition
Period pain, dysmenorrhoea
Class
Women's health
Description
Period pain, known medically as primary dysmenorrhoea, is a cramp like pain or ache in the lower part of the body that occurs at the time when monthly bleeding or menstruation starts. Sometimes, the pain may extend into the back, thighs and pelvic area.

Many women experience period pain, it is one of the most common gynaecological conditions affecting women of reproductive age. Although exact figures are impossible to determine, it is estimated that about 40% to 70% of women who have periods suffer from period pain and, in about 10% of these, the pain is so severe that it interrupts normal daily activities. Absenteeism from school or work can occur in up to 17% of women who suffer from severe period pain.

Period pain starts shortly after the age at which menstruation first begins. It is rare to first appear after the age of 30. Period pain is more painful and is more likely to occur in teenagers and adolescents, and becomes less frequent and less severe as the woman gets older.

If period pain does first appear after the age of 30, or if pain is particularly severe or occurs at times other than when having periods, it may be a sign of another condition called endometriosis. Endometriosis occurs when fragments of the uterus lining escape into the abdominal cavity instead of being flushed out with a period. These fragments will behave much as the uterus does every month and can cause severe pain as they remain trapped within the abdomen. (see separate article on Endometriosis)
Causes
If a woman does not become pregnant during her menstrual cycle, the lining of the uterus (called the endometrium) is removed with her period so that a new lining may be made for her next cycle. The breakdown of the cells forming the endometrium releases chemicals called prostaglandins.

Women who suffer from severe period pain have been found to have much higher levels of prostaglandins than those women who have mild or no period pain. Prostaglandins have a number of effects. They cause contraction of the muscles lining the uterus which helps remove the endometrium. The contractions decrease blood flow to the area so the uterus lacks oxygen (hypoxia), and it this hypoxia that triggers the spasmodic pain.

The prostaglandins also cause inflammation and increase the sensation of pain caused by other chemicals released when the endometrium breaks down. All of these effects combine together to cause the cramping ache of period pain. Further effects of prostaglandins may be responsible for the gastrointestinal symptoms of diarrhoea and nausea that frequently accompany period pain.
Symptoms
Cramp in the lower abdomen, lower back and thighs are all symptoms of period pain. The cramping pain usually begins a few hours before the start of the period and lasts from several hours to 2 or 3 days. Other symptoms include dizziness, fainting, diarrhoea, sickness and headache.
Treatment
Non-steroidal anti-inflammatory drugs are the most widely used treatment for period pain. These drugs inhibit the production of prostaglandins and so help reduce the feelings of cramp and pain. Mild non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen may be bought over-the-counter without the need for a prescription, but aspirin should not be used by children under 16 years of age. Stronger non-steroidal anti-inflammatory drugs such as mefenamic acid are available on prescription. These drugs should not be taken by people with a history of allergic reactions to non-steroidal anti-inflammatory drugs or those with a history of stomach problems.

Other mild painkillers or analgesics such as paracetamol are also available over-the-counter without a prescription and are suitable for the relief of mild to moderate period pain and headaches. Stronger analgesics such as codeine or dihydrocodeine can be used for acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone, but it is important that codeine or dihydrocodeine are used only for short term treatment and taken for no more than 3 days as they may cause addiction.

Combined oral contraceptives and progestogens (derivatives of the natural sex hormone progesterone) such as dydrogesterone and norethisterone may be used to treat very severe period pain. They work by thinning the endometrium, reducing menstrual blood flow and suppressing ovulation. An intra-uterine contraceptive device that slowly releases the progestogen, levonorgestrel is a further option if long tern contraception is also needed.

Where cramping is a particular problem, antispasmodic agents such as alverine citrate may help to relax the muscles of the uterus.
When to see your pharmacist
Non-steroidal anti-inflammatory drugs and mild analgesics are available in a wide variety of strengths, combinations and formulations from your local pharmacy without the need for a prescription. Always explain to the pharmacist why you are buying these medicines and let your pharmacist know who the medicine is for, in particular if the person has any history of allergic reactions or stomach problems or is likely to be pregnant. You should describe the symptoms to the pharmacist, including when they occur, and let your pharmacist know if you have taken anything before to treat period pain or are taking any other medicines or health supplements to treat other conditions.
When to see your doctor
There is no reason for any woman to suffer period pain in silence. Do not hesitate to see your doctor if you find that your periods are very painful or interfering with your daily activities. Your doctor will ask you to describe your symptoms and when they appear in relation to your periods to confirm a diagnosis of primary dysmenorrhoea.

You should also see your doctor if you are over 30 and develop period pain for the first time, if you experience pain at times other than during your period, if your periods are heavier or more painful than usual, if your periods become irregular, if there is bleeding between periods, if there is an unusual discharge from the vagina or if you have bleeding, pain or a fever after sex. These symptoms could be a sign of other conditions and your doctor will need to examine you or refer you to a specialist for further tests to determine their cause.
Living with period pain
Although period pain can be very distressing and can upset your social and professional plans, an important point to remember is that if you have primary dysmenorrhoea, ie if your doctor has found no other reason for your period pain, it will not affect your fertility or chances of having a baby. Also, as you get older, or after having a baby, the severity of period pain tends to decrease.

In the meantime, try not to let period pain control your life. There are a number of self-help measures that can reduce the impact that period pain has on your life.

Try to develop a healthy life-style. Regular exercise has been shown to increase the level of the body's own natural pain killers, called endorphins. Endorphins may help reduce period pain and help lift feelings of depressed mood. A diet rich in fresh fruit and vegetables can reduce the risk of constipation which is thought to make period pain worse by a full bowel pressing on the uterus and by creating feelings of listlessness.

When period pain starts, try placing a hot water bottle on the lower part of the stomach. Many women find that this brings relief.

If your periods are regular and you usually need to take pain killers to control period pain, then take them when you expect your period to begin. All non-steroidal anti-inflammatory drugs and analgesics are most effective if taken at the first signs of period pain developing, rather than waiting until the pain has got worse. However, none should be taken too frequently, their use should be limited to the time when they are needed.

You may also want to try alternative treatments to drugs to relieve period pain. Some women find that taking supplements containing omega-3 fish oils helps, probably by the omega-3 fish oils having an anti-inflammatory action.

There is also a small machine called a TENS (transcutaneous electrical nerve stimulation) which relieves pain. The TENS sends a small electric charge that blocks the nerves carrying pain or releases the body's own natural analgesic endorphin.

Other suggested remedies include vitamin E, magnesium supplements, herbal remedies and acupuncture, but there is insufficient clinical evidence to suggest that they work.

If you prefer to try omega-3 fish oil supplements, a TENS machine or other supplements your pharmacist will be able to advise you and supply many of these items.
Useful Tips
  • A soak in a warm bath can help ease the pain
  • Try placing a hot water bottle over your stomach
  • Remember to take a painkiller as soon as you start feeling the pain
  • Take painkillers only when you need them and do not exceed the stated dose


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