|What Are Painful Periods?
The majority of women experience painful periods at some time in their life. However in about 10 percent of cases symptoms are so severe that they impact on daily life. One controlled Norwegian study showed that 14 percent of women between the ages of 20 and 35 experience menses painful enough to cause them to stay home from college or work. The medical term for debilitating painful periods is dysmenorrhea. Dysmenorrhea may also occur alongside heavy periods (a condition known as menorrhagia). Primary dysmenorrhea is the most common type of painful menstruation and involves cramps and abdominal/lower back pain. It is not caused by any underlying condition and is more typical in teenagers and young women. It usually starts a year or two after menarche (first period). Primary dysmenorrhea symptoms usually subside by the late 20s or after a first pregnancy, although most women continue to experience some degree of pain or discomfort until menopause (inflaming temporarily after instances like a miscarriage or delivery and childbirth). Secondary dysmenorrhea is slightly less common. In this case severe menstrual pain is caused by an underlying condition such as endometriosis, pelvic inflammatory disease (PID), uterine fibroids, and ovarian cysts or by using an IUD device. Women in their 30s and 40s are more likely to suffer from secondary dysmenorrhea than primary.
What Are The Causes?
Once blamed on psychosomatic factors (if only you thought more positively...), painful periods are now believed to be caused by an excess of prostaglandins. Prostaglandins are hormone like substances which help the uterus to contract (squeeze), causing the lining to shed and a menstruation bleed to begin. Where there is an excess of prostaglandins, the uterus may contract too hard, which reduces oxygen supply to tissues in the area, causing pain.
What Are The Symptoms?
Generally symptoms only appear a year or two after a girl’s menarche and disappear again by the mid 20s or after a first pregnancy. Primary dysmenorrhea is typified by severe cramps and shooting pain:
• The pain begins in the abdomen (along with cramps) and sometimes radiates to the lower back, thighs, hips and legs.
How Is It Diagnosed?
As there is no universally accepted standard for the diagnosis of painful periods (or premenstrual syndrome, PMS for that matter), most doctors just diagnose primary dysmenorrhea by asking about the symptoms (which is more straight forward if you are a teenager or in your early 20s). The doctor may also quickly check the abdomen to ensure there are no abnormalities (which there should not be with primary dysmenorrhea). An internal exam is only necessary where secondary dysmenorrhea is suspected.
How Is It Treated?
Most women with painful periods treat pain with nonsteroidal anti-inflammatory painkillers (NSAIDs) such as ibuprofen (brand names Advil, Nuprin, Motrin) and aspirin (Ascriptin, Bayer and Ecotrin). NSAIDs work by blocking the effect of prostaglandins which are thought to cause the pain. Always take the first dose of your painkiller as soon as pain begins, or as soon as bleeding begins, whichever comes first. Some pharmacists recommend taking a pill one day before menstruation is due as a preventative measure. Note: Aspirin during pregnancy (or where pregnancy is suspected) should be avoided.
Hormonal Contraceptives - The Pill
The 'pill' is one of the most popular forms of medication for helping to stabilize hormone swings and regulate a menstrual cycle. The birth control implants Implanon and birth control injections Depo-Provera have been shown to be effective for reducing the symptoms of dysmenorrhea. The intrauterine system (IUD) Mirena has also seen some success.
• Applying heat such as a hot water to the affected area can help menstrual cramps. Also try applying a deep-heating oil like tiger balm. Also hot baths. See also PMS treatment and how can I relieve period cramps?
• Some studies show 'promising' improvement in symptoms of women suffering from dysmenorrhea when they undergo alternative treatments such as acupuncture, yoga, chiropractic care (spine manipulation) and acupressure. Treatment with transcutaneous electrical nerve stimulation (called TENS), often used by chronic pain sufferers, seems to be effective.
• There is some evidence that herbal therapies, including Chinese medicine may help primary dysmenorrhea. One study indicated that symptoms appeared to improve when a treatment with extract of guava leaf was applied.
• Several nutritional supplements appear effective in treating dysmenorrhea, including: vitamin E and B1, omega-3, calcium-magnesium and zinc. Several studies indicate that omega-3 can actually reverse the symptoms of dysmenorrhea. A good source of omega-3 is flax oil, but you can also take a supplement. Another controlled study showed that regularly taking a B1 vitamin helped 87 percent of women with dysmenorrhea. Ask your pharmacist about taking a daily dose of B vitamins.
• Mild cramps may be helped with herbal teas such as red raspberry leaves or partridgeberry. Moderate cramps may be helped with chamomile or sweet lemon balm tea.
• Some women find a strong alcoholic drink useful for relaxing uterine muscles if pain is particularly bad. Just the excuse we were looking for...
Secondary dysmenorrhea is severe menstrual pain caused by a specific condition such as endometriosis, uterine fibroids, PID, ovarian cysts or the presence of an IUD.
What Are The Symptoms?
Symptoms are much the same as primary dysmenorrhea: painful cramps, spasms and a dull or severe pain in the abdomen which can radiate to the lower back and legs. Women also experience fainting, dizziness, vomiting, nausea and breast soreness. In 5 percent of cases, symptoms are strong enough to interfere with everyday life. However, the following is a list of issues which may indicate secondary, rather than primary dysmenorrhea:
• A sudden change in pain pattern during menstruation. If you are used to certain symptoms, but pain now is sharper, lasts longer or appears in a slightly different area.
How Is It Treated?
If any of the above appears, consult with your doctor who will probably examine your abdomen and carry out an internal exam to check the womb and pelvis. If a problem, like fibroids or endometriosis is suspected, you may be referred to a gynecologist for further testing and treatment. Treatment will be centered on the underlying condition rather than dysmenorrhea. See for example, fibroids treatment and endometriosis treatment.
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