Summary

Painful Menstrual Cramps is one of the symptoms of a condition called Dysmenorrhea in which, some teenage girls or young women go through severe symptoms, during their periods. In addition to cramps, the condition manifests as excess pain, more than usual bleeding, nausea, diarrhoea, etc. While the condition may improve with time, most people do heal with medication and home remedies. In this article, we will learn more.

Introduction

Upon reaching puberty, and till menopause, a girl/woman goes through monthly menstrual cycles. During these cycles, simply called ‘periods’, the ovaries release an egg while the uterus sheds its lining. Muscles in the uterine wall contract in order to shed the lining. A set of hormone-like chemicals, called prostaglandins, secreted in the uterine lining during these cycles, enable these contractions.

While a small quantity of prostaglandins and mild uterine-contractions are normal, in some women, these chemicals are found in higher quantities. As a result, the uterine contractions are stronger. These result in stomach cramps, pain in the lower abdomen, and in some cases nausea and diarrhoea. These symptoms begin the day before the periods start and lasts for up to 2 days afterwards.

Teenage girls show these symptoms a couple of years after the first period, while some women show them in their early or mid-20s. In some cases, the condition improves or even disappears with age. But in most cases, treatment may be required. Again, its important to note that symptoms can be unique from woman to woman and may be mild to severe, depending on the person’s tolerance to pain. Cramps is just one of the symptoms, and for the purpose of this article, we are discussing the condition dysmenorrhea, which causes the cramps.

Dysmenorrhea symptoms can disrupt the girl/woman’s academic, professional and personal lives. That is why, its regarded as a serious condition that deserves attention and treatment.

Types of Dysmenorrhea

• Primary: This is generally not a cause for worry, as there is no underlying condition in the body that is causing the cramps or other symptoms. Simple home-remedies will work and, in some cases, the gynaecologist may prescribe some medication. This condition generally develops a few years after the first period begins.
• Secondary: In this, there is a clear reason, a defect, an abnormality or some condition in the body that is causing painful periods, or cramps, or excess bleeding, or more than one of these. This can develop any time in the teens, early 20s or mid-20s. Possible causes are discussed below.

Causes

• Premenstrual syndrome (PMS): One to 2 weeks before the period begins, there are hormonal changes in the body. In some girls/women, these changes can be drastic and cause strong symptoms which typically go away once the period begins.
• Endometriosis: There is a unique tissue that lines the uterus. When the same tissue starts growing outside the uterus such as on the ovaries, on the fallopian tubes or on the tissue that lines the pelvis, the condition is called endometriosis. It can be a painful condition, one of the symptoms of which is painful periods and cramps.
• Fibroids in the uterus: These are non-cancerous tumours that grow inside the uterus. They put pressure on the uterus and result in excessive pain and bleeding during periods, in some women. In most women, however, they don’t show any symptoms.
• Pelvic inflammatory disease (PID): This is an infection of the reproductive organs such as the uterus, ovaries and fallopian tubes. It’s generally caused by sexually transmitted bacteria and results in inflammation, painful periods and cramps.
• Adenomyosis: In this condition, the tissue that lines the uterine wall grows into the muscles of the uterine wall. It results in pressure on the uterus, inflammation, longer and heavier periods marked by excessive bleeding, pain and cramps.
• Cervical stenosis: This is a rare condition in which the opening of the uterus, the cervix, is very small or narrow that it can slow down the menstrual flow. This increases the pressure inside the uterus which causes pain and cramps.
• Infections in the reproductive organs, or pelvic region
• An ectopic pregnancy: This is an abnormal pregnancy in which the fertilized embryo deposits itself outside the uterus, for example inside the fallopian tubes and develops there. Most often, such a pregnancy is terminated.
• IUD or intrauterine device, which is one of the methods used for birth control
• Miscarriage or a loss of pregnancy
• Growths in the pelvis such as tumours, polyps or ovarian cysts

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Risk Factors

• Being under 30 years of age
• Heavy smoking
• Frequent alcohol consumption
• Has not been pregnant till date
• Reaching puberty before 11 years of age
• The girl/woman bleeds heavily during periods (menorrhagia)
• The girl/woman has irregular menstrual bleeding (metrorrhagia)
• The girl/woman has a family history of dysmenorrhea
• The girl/woman is overweight or obese
• The girl/woman lives a sedentary lifestyle with very little exercise

Symptoms

• Throbbing or cramping pain in the lower abdomen
• Dull constant ache in the abdomen and pelvis
• Severe pain in the back or thighs, which begins a day before start of periods, and improves over the next 3 days
• Intermittent pain in the back and thighs that can be mild or severe
• Nausea and vomiting
• Diarrhoea
• Dizziness and fainting
• Excess fatigue and weakness
• Headache
• A flu-like feeling
• Irritability and poor interest in studies, work or extra-curricular activities

When to see a doctor

• Continuous pain after placement of an IUD
• At least three, consecutive, painful periods
• Passing blood clots during periods
• Cramping accompanied by severe nausea and diarrhoea
• Pelvic pain when there are no periods
• Fever and chills
• Severe pelvic pain
• Sudden pain, especially if the girl/woman is pregnant
• A foul-smelling vaginal discharge

Diagnosis

• Imaging tests such as a CT scan or an MRI
• Pregnancy test, if periods have been irregular
• Physical examination: A complete abdominal and pelvic examination is done by the gynaecologist by using her hands. She will infer the size and shape of the vagina, cervix, and uterus by feeling them, and will also feel the ovaries.
• Pelvic ultrasound: The ultrasound machine emits sound waves which then bounce off tissues in the body, and are captured to create an image. The ultrasound device is inserted into the vagina and is done to check for, or rule out endometriosis, uterine adenomyosis and uterine fibroids. This test is generally not done for adolescents.
• Laparoscopy: In this procedure, the doctor makes tiny incisions on the abdomen and passes a lighted, fibre-optic tube with camera-lens fitted at the end. This helps check for, or rule out endometriosis, ovarian cysts, fibroids, adhesions and ectopic pregnancy. This test is generally not done for adolescents.
• Hysteroscopy: This is similar to a laparoscopy. However, here, no incisions are made and the lighted fibre-optic tube with camera lens is inserted into the vagina. This helps the gynaecologist look inside the cervix and uterus.

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Also Read: The importance of Annual Gynaecological Health Check-up

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Treatment

There are various treatment options which are a mix of allopathic medicine, alternate medicine, supplements, home remedies and birth control measures.

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These drugs help relieve pain and inflammation. When used for dysmenorrhea, they should be taken as soon as bleeding or other signs of a period begin, and must be taken regularly for the next 3 days. While some of these drugs are available over-the-counter, do not take any medication without the advice of your gynaecologist.
• Anti-depressants: These may not reduce the pain and cramps much. However, they help relieve the mood swings and depression which is one of the outcomes of dysmenorrhea. With mood-swings out of the way, the girl/woman can deal with the condition better.
• Birth control options: If the girl/woman does not wish to get pregnant, she can use birth-control measures to reduce the pain from dysmenorrhea. They work by thinning down the uterine lining. In the process, the secretion of prostaglandins is reduced, thereby decreasing the uterine contractions, menstrual bleeding, pain and cramps. Measures include the pill, a patch, the vaginal ring, injections, hormone-releasing intrauterine device (IUD), and implants.
• Continuous dosing: The above birth-control measures are taken on a schedule, which will trigger menstrual bleeding once a month. In this method, the pain, bleeding and cramps are reduced but not totally eliminated. However, if they are taken continuously, the bleeding and associated pain can be totally eliminated. The same pill, patch, ring and injections are used but in a particular fashion as suggested by the gynaecologist. In some people, there will still be very light and intermittent bleeding, without any pains or cramps.
• Heat: This is a home remedy. Heat is applied to the lower abdomen using a heating pad, a hot-water bottle, or a self-heating patch. This is combined with the use of NSAID drugs. Care should be taken that the temperature does not exceed 40 degrees centigrade, to eliminate the risk of burns.
• Alternate treatments: A range of dietary supplements, vitamin supplements and herbal treatments are popular in many parts of the world. These are popularized through word-of-mouth. However, there is no clinical data available on their efficacy, so one can try them at their own risk.
• Exercise: Physical activity does wonders to reduce menstrual symptoms such as pain and cramps. They help improve the mood and ensure good blood-circulation to the uterus. However, the exercise should be mild such as walking, brisk-walking, simple yogasanas and some free-hand exercises. Heavy or strenuous exercise must be avoided as it can aggravate the symptoms.
• Alternative medicine, also called complementary medicine. Yoga and acupuncture are popular in some parts of the world to reduce pain associated with periods.
• Transcutaneous electrical nerve stimulation (TENS): This is a minimally invasive procedure. In this, the girl/woman wears a small battery-pack on a belt, while electrode patches that are connected to this battery pack, are applied on the skin. The battery-pack generates mild electrical pulses that are sent to the electrode patches. These pulses help stimulate the release of chemicals which can block or minimize the nerve impulses associated with period pain.
• Surgery: This helps remove ovarian cysts, uterine fibroids and any endometriosis implants.
• Hysterectomy: If the woman no longer wishes to give birth to children, she can choose to have her uterus removed altogether. This will stop the periods completely, and is similar to having a menopause. However, this option is rarely exercised. It is recommended only when all other options have failed. While earlier, hysterectomy was an open-surgical procedure, today, minimally invasive methods are available.

Dysmenorrhea may disrupt a woman’s life but it is not untreatable. Lifestyle adjustments, medications, and even surgery can help alleviate the pain and improve the quality of life. If you or someone you know is struggling with painful menstrual cramps, don’t hesitate to reach out for professional medical support. Kauvery Hospital, with its branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, is dedicated to offering customized and effective treatments for Dysmenorrhea, coupled with compassionate care. We’re at your service to make each day a comfortable one.

 

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801

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