Understanding Menstrual Pain, Cramp

Menstrual pain affects over 25 per cent of women

By Dr. Goke Akinrogunde

Sometimes, menstrual pain is used synonymously with menstrual cramps, but the latter may also refer to menstrual uterine contractions, which are generally of higher strength, duration and frequency than in the rest of the menstrual cycle.

Menstrual pain, which is medically described as dysmenorrhoea is a female medical condition of pain during menstruation that interferes with daily activities.
The pain of dysmenorrhea can come in different modes, including sharp, throbbing, dull, nauseating, burning, or shooting pain. It may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Sometimes, menstrual pain exists with excessively heavy blood loss during menses, especially in symptomatic fibroid cases.

Types of menstrual pain Secondary dysmenorrhea
The term secondary dysmenorrhea is used when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the womb (uterus). Secondary dysmenorrhea is diagnosed when menstrual cramps are caused by other conditions such as endometriosis, fibroid tumors, pelvic adhesions, and ovarian cysts or by the use of an interuterine device (IUD) for birth control. Usual appropriate treatment of the implicated ailment (where this is possible) would normally result to an end of the menstrual pain in the victim.

Primary dysmenorrhea
On the other hand, the term primary dysmenorrhea is used when none of the aforementioned is detected.
Some research findings indicated that dysmenorrhea occur approximately in 25% of women, this is probably an under-estimation. Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reported cases usually declining with age. The prevalence in adolescent females has been reported to be between 67.2 per cent and 90 per cent.
It has been generally noted that childbearing relieves menstrual pain, although this does not always occur.

Signs and symptoms
The main symptom of dysmenorrhea is pain concentrated in the lower abdomen, in the navel region or at the lower region of the abdomen. It is also commonly felt in the right or left abdomen and the pain can also radiate to the thighs and lower back.

In some cases, symptoms often co-occurring with menstrual pain include nausea and vomiting, diarrhea or constipation, headache, dizziness, disorientation, hypersensitivity to sound, light, smell and touch, fainting, fatigue and general irritability. Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels in the body that occur with ovulation. Hence, in some cases, the use of certain types of birth control pills prevents the symptoms of dysmenorrhea, because the birth control pills stop ovulation from taking place.

Causes
Generally in all women in their reproductive age, during a woman’s menstrual cycle, the innermost lining of the womb (endometrium) thickens in preparation for potential pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the endometrium built-up uterine tissue is thus not needed and thus shed as the menses.
Molecular compounds called prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents. Release of prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These substances are thought to be a major factor in primary menstrual pain. When the uterine muscles contract, they constrict the blood supply to the tissue of the endometrium, which, in turn, breaks down and dies. These uterine contractions continue as they squeeze the old, dead endometrial tissue through the cervix and out of the body through the vagina. These contractions, and the resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or “cramps” experienced during menstruation.

Controlling menstrual pain; Hormonal contraceptives
As noted above, the use of hormonal contraception can improve or relieve symptoms of primary dysmenorrhea, especially the more potent long acting ones like Norplant (usually buried under the skin and lasting five years plus) and injectable Depo-provera (lasting some three months).
As noted above, menstrual cramps are thought to be related to the naturally occurring prostaglandin, which causes the uterus to contract. If a woman does not ovulate, it is unlikely that she will encounter cramps during her period. For this reason, physicians often prescribe oral contraceptives to ease painful periods. However, it should noted that birth control pills cause abnormal bleeding in some women.

NSAIDs and other pain relievers
The class of pain relievers known as Non-steroidal anti-inflammatory drugs (NSAIDs) – Aspirin, Ibuprofen, Diclofenac etc – are effective in relieving the pain of primary dysmenorrhea. The drawback however is that in some individuals they can have side effects of nausea, dyspepsia, peptic ulcer, and diarrhea. People who are unable to take the more common NSAIDs, may be prescribed alternative medications as these medications are best avoided by peptic ulcer patients.

NSAIDs can be used around the clock as soon as one notices the first sign of your period can help to reduce the severity of cramps in many women by inhibiting the release of prostaglandins. Of course, be sure not to exceed the daily maximum as described on the medication’s label. Acetaminophen (paracetamol) also helps the pain, but it does not have the effect on prostagladins.

Regular physical activity often reduces cramping in some women.
Similarly, supplementing diet with zinc and calcium has been found to reduce cramps, bloating, and related symptoms.

Physical measure – Heating pad
A warm bath with the use of aromatherapy or a heating pad on your lower abdomen or back has been noted to help with menstrual pain. In the absence of a heating pad, a heating pad substitute can be made at home.

In same vein, there are documented cases of individuals who measures in form of special program of physical exercises and related physiotherapy measures who reported respite from menstrual pain / cramps in the course of the program.