I always suffer terrible cramps

By: DR TOROOTI MWIRIGI

Dysmenorrhea is among the most common problems associated with menstruation. It affects many young women globally and can be a source of discomfort. Dysmenorrhoea refers to painful menstruation of sufficient magnitude so as to incapacitate a woman’s day to day activities such as going to school or work.

As explained by Dr Elizabeth W. Njoroge, Consultant Obstetrician Gynecologist, it is difficult to determine exactly how prevalent the condition is but some studies have quoted as much as 90per cent of adolescent girls being affected with about 5-10 per cent being severely impacted.

Dear doc,

I was experiencing too much pain during my menstrual period. On visiting a doctor, I was told that what I have is a condition called dysmenorrhoea. My question is what causes this condition?

Kagendo.

Dear Kagendo,

Painful periods occur as a result of contractions of uterine muscle. The uterus contracts the whole time during the menstrual cycle.

It is thought that normal body chemicals called prostaglandins build up in the lining of the uterus in the second half of the cycle after ovulation. These prostaglandins help the uterus to contract and remove the inner lining during the menses.

In women who have dysmenorrhoea, there seems to be a buildup of too much prostaglandins or the uterine muscle is ultra sensitive to the normal production of the prostaglandins. This causes increased uterine muscle contraction. As a result, the blood supply to the uterus is reduced and leads to pain.

Dear doc,

I am 13 years old and just started having menstrual period. My question is how can one tell they have dysmenorrhoea?

Jacinta M.

Dear Jacinta,

Usually, dysmenorrhoea causes symptoms such as;

Pain that begins a few hours before or just after the onset of the menses and may last even up to 48-72 hours. Pain may come in form of intense spasms or can appear as dull but continuous.

Crampy or occasional pain that begins in the lower abdomen. The pain may radiate to the lower back and inner thighs.

Clots in the menstrual blood

Dysmenorrhoea may also be associated with nausea, upset stomach, vomiting, diarrhea, bloating, headache, fatigue and rarely fainting.

Note that these symptoms can vary in different women, and also from one menstrual period to another.

Dear doc,

My periods are usually accompanied by a lot of pain. I was told this common in women and will ease by itself. Should I see a doctor or just wait for the problem to ease? Please advise

Troubled teen.

Dear Troubled teen,

It is advisable to see a doctor when the pain is too much and affects your daily routine, or if the pain is worsening or unresponsive to over the counter pain relief medications. If you feel depressed, get suicidal thoughts, the periods are also concurrently heavy, and causing anaemia, a doctor will be able to identify the cause of your symptoms and then suggest best treatment options.

Dear doc,

I was told I have primary dysmenorrhea by the school nurse. What other types of dysmenorrhea are there?

Valentine.

Dear Valentine,

Primary dysmenorrhoea refers to menstrual pain that occur without any specific pelvic condition. The pain may start with the beginning of the period and can last for 24-72 hours. This is the commonest type of dysmenorrhoea among adolescent girls.

The other type is secondary dysmenorrhea. This is painful menstrual period associated with underlying pelvic condition. The pain can come some days before period and can last all through the period or even persist after period.

Secondary dysmenorrhoea may be caused by conditions such as pelvic inflammatory disease, endometriosis, and uterine fibroids among others.

Dear doc,

My 14 year old daughter has been diagnosed with dysmenorrhoea. What treatment options does she have?

Mama Celine,

Dear Mama Celine,

Usually, the severity of symptoms is used as a determinant of whether medical treatment is necessary. Some women with mild cases of dysmenorrhoea are able to keep the pain controlled by applying home remedies like heating packs. For others however, over-the-counter pain relievers and other medications are needed to treat the condition. These include;

Painkilling medicine such as paracetamol.

Non-Steroidal Anti-Inflammatory Drugs such as ibuprofen- these work by blocking the effect of the prostaglandins.

Combined Oral Contraceptive Pills- these help reduce period pain as they cause less growth of the inner lining of the uterus and reduce prostaglandin production.

This results in less uterine muscle cramping. When the lining of the womb is thinner, the uterine muscles do not need to contract much when shedding part of menstrual cycle. The period also becomes lighter.

Anti-spasmodics- these kinds of drugs help suppress muscle spasms.

Intrauterine system aka MIRENA*- it is a good alternative for those who for some reason cannot take combined contraceptive pill.

These questions have been answered and compiled by Dr. Torooti Mwirigi and the panel of DN2 Health Professionals. Have a question about your health? Please send it to nation@askadoc.co.ke

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How to minimise the pain of dysmenorrhea

Dysmenorrhea is a painful reality for many women and young girls . In addition to medication, there are other things one can do to be able to cope better with the condition. Though there is no guarantee that the pain will completely fade away, taking these measures often help ease it.

Engage in exercise: Exercising is an important way of relieving pain. One may not be comfortable doing exercises when in pain, but engaging in simple exercises like swimming, cycling, walking, stretching, or just staying physically active by doing simple house chores can help in relieving pain from dysmenorrhoea. Exercise encourages the body to release some chemicals called endorphins that help in relieving pain. Aim at some physical activity that lasts for 30 minutes each day. For effectiveness, one should start these exercises before period starts.

Heat: one can apply either a hot water bottle or a heat pad, whichever works better, in order to reduce pain. The heating pad or hot water bottle can be placed either on the lower back or lower abdomen. Avoid using boiling water as this may hurt and even damage the skin. The heat therapy is effective in pain reduction but it depends on the individual or available means at the time of the pain.

Warm shower or bath: in a similar way in which heat relieves pain, taking a hot shower or bath helps reduce pain in addition to making one relax.

Abdominal massage; taking light circular massage around the lower abdomen or lower back can help in relieving discomfort.

Stop smoking; smoking is associated with increased risk of menstrual pain. Hence if one is a smoker, quitting smoking will help avoid dysmenorrhoea or other menstrual related pains.

Similarly, alcohol use can increase the risk of dysmenorrhoea. Cutting down on alcohol consumption can help reduce the risk.

Relaxation therapy; relaxation techniques are techniques that help distract a person from the pain. For example taking some yoga sessions or meditating can help distract from the pain and discomfort experienced during dysmenorrhoea.

Transcutaneous electronic nerve stimulation: a TENS machine operates by releasing small electrical impulses through sticky pads put on the skin which stimulate the nerve around the pelvic area and assist in blocking pain.

Maintain a healthy diet: in addition to other therapies, diet is also important in preventing pain from menstruation. Research has demonstrated that, omega 3 fatty acids, vitamin E, vitamin B-1, vitamin B-6 and magnesium supplements may help reduce pain during menstruation. In addition eating diet rich in fiber, fruits and veggies can be an important supplement to help reduce pain. Reducing sugary foods also help in minimsing pain.

Reduce stress: Stress is an aggravating factor for pain. If you have menstrual related pain or any other pain, stress may even worsen it. Therefore, reducing psychological stress can reduce the severity of pain.

Get adequate sleep: ensure to get sufficient and regular sleep prior to and during the menstrual period. This helps the body cope with discomfort.

Acupuncture: this technique can be used to relieve pain associated with dysmenorrhoea. Fine needles are inserted into specific parts on the body (acupuncture points) depending on the condition. Acupuncture treatment stimulates muscle tissue and nerves beneath the skin. This in turn causes the body to produce pain-relieving chemicals, like endorphins.