Dysmenorrhoea painful periods

14Jan, 2023

Dysmenorrhoea- Painful periods? What you need to know....

What is dysmenorrhoea? Is it common?

Dysmenorrhoea (pronounced as dis-men-or-rhea) is the scientific term for painful periods. Dysmenorrhoea is one of the commonest complaints that we come across in practice.

Why are periods painful?

There are many theories. Finally-as the final common pathway- it is because of the release of pain-generating chemicals called the prostaglandins (PGs) that pain is caused. As a corollary, painkillers being anti-prostaglandins help relieve pain!

Is a painful period abnormal?

That depends on what is the cause of pain. Dysmenorrhoea is categorized as primary when it occurs de-novo, without any underlying disease. Secondary dysmenorrhoea is when there is some disorder in the reproductive organs. Obviously, secondary dysmenorrhoea is abnormal and primary dysmenorrhoea is considered to be physiological (normal function)

What is primary Dysmenorrhoea?

It is stated that primary dysmenorrhoea is physiological. It means the reproductive organs are functioning normally. Often primary dysmenorrhoea indicates that the ovaries are functioning normally and that the cycle is ovulatory! That is, as is expected, the ovaries are producing eggs and the system is normal!

Does it mean that the egg is produced only those times when periods are painful?

No. Though primary dysmenorrhoea is an indirect evidence of ovulation, it does not follow that all ovulatory cycles are painful.

What are the characteristics of primary dysmenorrhoea?

Most often, girls have painless periods for a few months to 1-2 years after they begin their menstrual cycle. This is because when the reproductive organs begin their function, they are still in the process of getting into the rhythm and the ovaries may not be functioning. Hence, they are anovulatory cycles-cycles occurring simply due to hormonal effects, without production of eggs.

However, after a few months, as the reproductive organs mature in functions and the ovaries begin to produce eggs and the periods may become painful.

Therefore, features of primary dysmenorrhoea are:

  • 1. Age of onset: Adolescence
  • 2. Occurs a few months AFTER menarche (first period)
  • 3. Begins a few hours before the onset of flow and persists for a few hours and gradually abates.
  • 4. Is not due to any dis-order of the reproductive organs.
  • 5. Nature of pain- Begins from lower back and radiates to the lower abdominal region. It is described as colicky or crampy, coming on in waves. For some girls pain may radiate to inner thighs and genital region.
  • 6. Patient profile : Mothers of girls with severe dysmenorrhoea are often sufferers themselves. This trend is more likely to be due to the social factors rather than a strong genetic association.

What is secondary dysmenorrhoea?

Painful periods occurring secondary to an underlying disorder of the reproductive organs is secondary dysmenorrhoea.

What are the features of secondary dysmenorrhoea?

As the cause is due to an underlying pathology, dysmenorrhoea may be one of the symptoms of the disease condition. For example: Fibroids are non-cancerous lumps that may form in the uterus. Fibroids can cause heavy periods, mass in the abdomen, infertility and as another feature, there may be dysmenorrhoea too.

What are the causes of secondary dysmenorrhoea?

Secondary dysmenorrhoea may be caused by many disorders .It could be due to

  • 1. Endometriosis: Condition where menstruation occurs within the abdomen also. Associated symptoms include infertility (inability to conceive), heavy periods, constant abdominal pain, tiredness, difficulty during intercourse and painful bowel movement.
  • 2. PID (Pelvic inflammatory disease) Infection of the uterus and the uterine tubes may result in inflammation (swelling, increased blood supply etc.) which results in the release of prostaglandins and hence pain. Associated symptoms include fever, white discharge and painful intercourse.
  • 3. Adenomyosis: A condition where the menstruation occurs within the muscle of the uterus (Myometrium) resulting in an enlarged uterus. Associated symptoms include heavy periods.
  • 4. Fibroid uterus: Associated symptoms as above.
  • 5. Pelvic adhesions: Previous pelvic operations like for ectopic pregnancy, ovarian cyst, cesarean section, appendicitis may all cause the internal structures (omentum, intestines) to get stuck to the uterus or ovaries and cause pain during periods.
  • 6. Other conditions where surgery has been performed on the uterus or the mouth of the uterus(cervix) causing distortion of the uterine cavity (Asherman’s syndrome) and narrowing of the cervix (cervical stenosis)
  • 7. Malformations of the uterus (Mullerian anomalies) may cause dysmenorrhoea due to various causes (associated endometriosis, non-communicating horns etc)

What is the nature of pain in secondary dysmenorrhoea?

Onset: Any time during the reproductive life. May be having painless periods for years after menarche before any of the disorders occur.

Duration of pain: Women often have progressive pelvic discomfort and heaviness several days before their periods. Pain increases during periods and persists throughout the flow, Gets relieved only by the time all the bleeding has stopped only to restart after a few days in a run up for the next cycle!

Nature of pain: As for primary dysmenorrhoea. But there is also an associated dull aching pain (endometriosis, PID) or dragging pain (adhesions) constant heaviness ( Adenomyosis) and painful intercourse (PID, endometriosis)

How is the cause of dysmenorrhoea diagnosed?

History often is suggestive for primary dysmenorrhoea. Young, unmarried girls do not need to undergo an internal examination if the history and nature of pain is obvious.. However, an ultrasound scan may be necessary to rule out the possibility of endometriotic cysts of the ovary or uterine malformations.

Patients suspected to be suffering from secondary dysmenorrhoea merit a detailed history, internal examination and an ultrasound to confirm the diagnosis.

At times, the diagnosis of adhesions and endometriosis is made only at diagnostic laparoscopy (keyhole surgery that enables visualization of internal organs real time)

Can dysmenorrhoea be treated?

Painful periods is a part of human physiology. In addition, pain threshold (capacity to tolerate pain) may vary amongst individuals.

Hence, medical help may be sought if girls feel they are unable to tolerate pain. Often, an explanation about the causation and reassurance might help the young woman to view the situation in a different perspective and help her to go through her periods without much ado. Alternatively, painkillers may be used during the period. If the pain is intolerable, we may use oral contraceptive pills that suppress ovulation and hence the period pain associated with ovulatory cycles.

However, in cases of secondary dysmenorrhoea, it is the associated symptoms of heavy flow, painful intercourse or infertility that brings a woman to us and pain may be just an associated complaint. Alternatively, painful periods could be the main presenting complaint too. The treatment of secondary dysmenorrhoea hence depends on treating the underlying conditions. There exists a wide range of treatment options depending on the severity and type of disease. These include medications during periods (mefanemic acid), antibiotics (for PID), Oral contraceptives (in endometriosis) and hormone injections also. Hormone releasing intra-uterine contraceptive device (Mirena coil) is also being used with good results in selected cases.

Surgical management includes laparoscopy (Keyhole surgery) which not only clinches the diagnosis but is also an operative method. Ovarian cysts may be removed during laparoscopy, adhesions released and even fibroid operated upon.

What is the last word?

If your periods become painful a few months after you have attained menarche, it is most probably a normal occurrence.

However if there is a sudden onset of pain during periods with or without white discharge, fever, painful intercourse or inability to get pregnant; then probably there is an underlying disease.

However, you are not to presume and make diagnosis yourself.

With the help of a gynaecologist, the cause may be determined and treated, enabling you to overcome the pain and get on with your routine.

For more info, Follow : medlineacademics.com

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