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Medical Article

Painful Periods (Dysmenorrhoea)

Painful periods are common in most women.  It is often mild, but for 1 in 10 women, the pain is severe to affect the day-to-day activities. This severe pain interfere the routine life of ladies. Menstrual pain in older women has specific cause. They have to undergo tests to find the cause; sometime problem in pelvis can also cause the pain.

Primary Dysmenorrhea:

Primary dymenorrhea is the cramping pain in the lower abdomen occurring before or during menstruation. Usually it affects young girls. The women with primary dysmenorrhea have increased production of endometrial prostaglandin, resulting in contraction of the uterine muscles. The compression in blood vessels leads to reduced blood supply to the muscles, this result in pain.

During the ovum or egg release the substances Prostaglandins are released. In the first year of menstruation, the egg may not be released in all the cycles, i.e., the cycles may be anovulatory. It is painless cycles.  The first day of primary dysmenorrahea may be most severe. Usullay it continues to two days. Symptoms like nausea, vomiting, dizziness, fatigue, headache and loose stools  will be seen on those days.

Secondary Dysmenorrhea:

Secondary dysmenorrhea is menstrual problem related to female reproductive organs or the pelvis. It is more likely to affect women during adulthood. The symptoms begins earlier in the menstrual cycle and lasts longer than common menstrual cramps. The main causes of secondary dysmenorrhea are listed below:

Conditions affecting pelvis :

Endometriosis: Endometriosis is the abnormal growth of cells similar to those that form the inside of the uterus, but it grow outside the uterus. Due to hormonal influence, it undergo changes and bleed during the menstrual cycle and cause severe pain.

Pelvic inflammatory disease: Pelvic inflammatory disease(PID) is an infection of the reproductive organs in women.  The pelvic organ includes the fallopian tubes, the ovaries, the cervix and the uterus. The infection first enter the vagina and cause an infection, this infection can move into the pelvic organs. The infection may occur due to childbirth or surgical procedures. During the periods, there will be pelvic pain, fever and vaginal discharge etc.

Pelvic congestion syndrome (PCS) :  There are multiple reasons causing Pelvic congestion syndrome.  The pain may be due to the presence of ovarian and pelvic varicosities, much like the leg pain resulting from lower extremity varicose veins. The severe pain felt during menstrual periods, following intercourse, prolonged standing or during pregnancy. Irritable bladder, abnormal menstrual bleeding, vaginal discharge, varicose veins on vulva, buttocks or thigh are associated symptoms.

Allen-Masters syndrome :  It is the damage of muscle layers in the pelvis which cause abnormally increased movement of the cervix. The damage often results after a traumatic surgical birth, induced abortion or excessive vaginal packing.

Conditions that affect the uterus

Adenomyosis  : Adenomyosis is a condition that involves the movement or encroachment, of the lining of the uterus into the muscle wall. This causes thickening of the uterine walls. It may lead to heavy or longer-than usual menstrual bleeding and pain during intercourse.

Fibroids:  Fibroids are benign muscle tumours that develop in or on a woman’s uterus. Sometimes, quite large tumors will develop and cause severe abdominal pain and heavy periods. The pain during intercourse and symptoms due to pressure over the bladder and rectum are the symptoms. The cause of fibroids is unknown.

Uterine polyps: uterine polyps are growths that arise from the uterus and extend into the uterine cavity. Polyps are prone to bleeding, and a uterine polyp that develops near the fallopian tubes may obstruct the opening of the tubes, possibly leading to difficulty in getting pregnant.

Intrauterine adhesions:  Intrauterine adhesions form when scar tissue builds up between the inner linings of the uterus causing the walls to bind together. The damage often occurs due to surgical procedures like dilatation and curettage (D&C) or removal of fibroids. The insertion of an intrauterine device like Copper-T or infection of the uterus causes the damage. Such patients suffer from infertility or repeated miscarriages. If the adhesion obstructs the flow of menstrual blood, pain may occur.

Congenital malformations:  Congenital uterine anomalies are malformations of the uterus like bicornuate uterus (uterus with two horns) and subseptate uterus (uterus with a partition within), which cause painful menstruation.

Intrauterine contraceptive device (IUCD) : An intrauterine contraceptive device is a small “T-shaped” contraceptive device which is placed in a woman’s uterus (womb). It can cause cramps during menstruation.

Conditions that affect the cervix and vagina

Cervical stenosis or occlusion:  Stenosis is the term used to the narrowing in passage of body. In Cervical stenosis the opening of the uterine cervix is narrowed, either partially or completely. It may occur from birth or due to procedure like a LEEP or infections, cancer or radiation.  It creates the risk of infertility or endometriosis.

Transverse vaginal septum :  It is a congenital utero-vaginal anomaly, occurs as a birth defect. The septum can be either complete or partial.  If it is complete, the symptoms of vaginal obstruction occur and the menstrual blood is unable to flow.

Conditions that affect the ovaries

Ovarian cysts and tumors : ovarian cysts are fluid filled swellings on the surface of the ovary. Most cysts are not cancerous and will not become cancerous. It creates conditions like irregular menstruation, discomfort during intercourse and problems with bowel and bladder function.