What Causes Painful Menstruation?

Posted on 2013-03-27 08:00:10

Dysmenorrhoea is derived from greek words; “dys” meaning difficulty and “menorrhea” referring to menstruation. Simply put, dysmenorrhoea means painful menstruation. Menstruation/ menses/ monthly periods all refer to the monthly flow of cellular debris, blood and mucosal tissue from the uterus through the vagina. Menses normally begin around 11 years to 14 years, although there have been recent reports of menses beginning at the age of 9 years. In the beginning, menses tend to be irregular but with time, they become regular, recurring every 21 to 35 days. Menses continue into the 40’s or 50’s, until the cessation which is referred to as menopause. Dysmenorrhea is a source of discomfort, annoyance and irritability for many women at least once a month. It is one of the most common problems related to menstruation in addition to Pre-Menstrual Syndrome (PMS) and amenorrhea (lack of menses).   Are there any other symptoms associated with dysmenorrhea? The pain of dysmenorrhea is described as cramping pain in the lower abdomen, just above the pubic bone. The pain is reported to be mild, moderate or severe. This pain may be accompanied by other symptoms including:
  • Lower back pain
  • Diarrhea
  • Nausea
  • Vomiting
  • Fatigue
  • Headache
  • Mood swings
  • Anxiety
  • Bloating or feeling of fullness in the stomach
  • Flu-like symptoms either just before menses or for the first few days of menses
Is dysmenorrhea common? Most women normally experience painful menstruation in their first 4 to 5 years of menstruation. The pain then reduces with advancing age, and also with childbirth for some women. If dysmenorrhea worsens with age, then there is need for further investigation to determine the root cause. It has been reported that 50-90% of women aged 18 years to 45 years world wide experience dysmenorrhea. According to a local clinician in Nairobi, dysmenorrhea is one of the most common complaint that bring young women to the clinic. School nurses in girls secondary schools also report that dysmenorrhea is a common complaint with very high statistics as reflected in the clinic attendance logs.   What are some of the effects of dysmenorrhoea? Dysmenorrhea can be severe enough to interfere with the performance of daily activities. It can lead to absenteeism from work and school or abandonment of other social activities and responsibilities.   Who is at risk of dysmenorrhea? All women are at risk of experiencing dysmenorrhea. However, there are some factors that increase the likelihood of dysmenorrhea which include:
  • Anxiety and stress
  • positive family history of dysmenorrhoea
  • heavy flow of menses
  • long menstrual periods
  • beginning menses at a very early age (before 11 years)
  • low body weight
  • obesity
  • continuous premenstrual complaints
  • smoking
  • alcohol consumption
Types of dysmenorrhea Dysmenorrhea is broadly divided into two types; primary and secondary dysmenorrhea. Primary dysmenorrhea – this is the pain that occurs during normal menses. There is no specific known cause for primary dysmenorrhea. There is no demonstrated illness in this type of dysmenorrhea, and most women tend to have normal pelvic anatomy. The pain in this type of dysmenorrhea tends to begin just before or at the onset of menses, and lasts between 1 to 3 days. Secondary dysmenorrhea - this is pain which occurs during menses but is caused by a disorder in the reproductive system as opposed to primary dysmenorrhea which occurs in women with normal anatomy of the pelvis. It is more common in women between 30 and 45 years, but can also occur in women as young as 25 years old. Pain associated with secondary dysmenorrhea is not limited to the onset or the duration of menses. It can persist even after menses. Some disorders that can cause secondary dysmenorrhea include:
  • pelvic inflammatory disease – this is an infection of the pelvic region, usually involving the uterus, fallopian tubes or surrounding pelvic structures.
  • Adenomyosis – This is a condition where the tissue that forms the inner lining of the uterus (endometrium) is found within the outer muscular layers of the uterus.
  • endometriosis – this is where tissue that forms the inner lining of the uterus is found in other areas outside of the uterus such as the ovaries, fallopian tubes, behind the uterus and even on the bladder.
  • uterine fibroids – these are non-cancerous (benign) muscular growths in the uterus.
  • Uterine adhesions
  • Other uterine conditions - cysts, polyps or tumours
  • Bladder diseases
It is advisable to visit a doctor if dysmenorrhea is getting worse with age or persisting despite treatment in order to rule out any of these conditions.