MENSTRUAL CRAMPS (DYSMENORRHEA)

 

Menstrual cramps are pain in the belly and pelvic areas that are experienced by a woman as a result of her menstrual period. Menstrual cramps are not the same as the discomfort felt during premenstrual syndrome (PMS). Although the symptoms of both disorders can sometimes be experienced as a continual process. Many women suffers from both PMS and menstrual cramps

How Common is Menstrual Cramps?

Menstrual cramps of some degree affects more than an estimated 50% of women and among these up to 15% would describe their menstrual cramps as severe. Nearly 90% of adolescent girls report having menstrual cramps.

What is Dysmenorrhea?

The medical term for menstrual cramps is dysmenorrhea. There are 2 types of dysmenorrhea primary and secondary.
In primary dysmenorrhea, there is no underlying gynaecological problem causing the pain. This type cramping may begin within 6 months to a year following menarche (the beginning of menstruation), the time when a girl starts having menstrual periods. Menstrual cramps typically do not begin before the onset of ovulation. Therefore, an adolescent girl may not experience dysmenorrhea until months to year following the onset of menstruation.
In secondary dysmenorrhea, some underlying abnormal conditions (usually involving a womans reproductive system), contributes the menstrual pain. Secondary dysmenorrhea may be evident at menarche, but more often the condition develops later.

What causes menstrual cramps

Each month the inner lining of the uterus (the endometrium) normally builds up in preparation for a possible pregnancy. After ovulation, if the egg is not fertilised by a sperm, no pregnancy will result and the current lining of the uterus is no longer needed. The woman oestrogen and progesterone  hormone and levels decline and the lining of the uterus becomes swollen and eventually shed as a menstrual flow and is replaced by a new lining in the next monthly cycle. When the old uterine lining begins to breakdown, molecular compounds called prostaglandins are released. These compounds cause the muscle of the uterus to contract. When the uterine muscles contract, they constrict the blood supply (vasoconstriction) to the endometrium. These contractions blocks the delivery of oxygen to the tissue of the endometrium which in turn breaks   down and dies and are shed as menstrual flow. Other substances known as leukotrieries are released and elevated at this time and may be related to the development of menstrual cramps.

Why are some Cramps so Painful?

Menstrual cramps are caused by uterine contractions that occur in response to prostaglandins and other chemicals. The cramping sensation is intensified when clots or pieces of bloody tissue from the lining of the uterus pass through the cervix, especially if a woman’s cervical canal is narrow.
The difference in pain may be due to the woman prostaglandins level. Women with menstrual cramps have elevated level of prostaglandins in the endometrium compared to women who do not experience cramps. Menstrual cramps are very similar to those pregnant woman experiences when she is given prostaglandin as an induction agent for labour.

What other Factors Influence Menstrual Cramps?

An unusually narrow cervical canal tends to increase menstrual cramps
A backwards tilting of the uterus (a retroverted uterus)
Lack of exercise is now recognised to contribute to painful menstrual cramps
It has long been taught that psychological factors also play a role. For example it is widely  accepted that emotional stress can increase the discomfort of menstrual cramps

What are the Symptoms of Menstrual Cramps?

Menstrual cramps are pains that begin in the lower abdomen and pelvis. The discomfort can extend to the lower back or legs. The cramps can be a quite painful or simply a dull ache. They can be periodic or continual. Menstrual cramps usually starts shortly before the menstrual period, peak within 24 hours after the onset of the bleeding and subside again after a day or two.
Menstrual cramps may be accompanied by a headache and or nausea which can lead to vomiting. Menstrual cramps can also be a accompanied by either constipation or diarrhea because the prostaplandins which cause the smooth muscles to contract are found in both the uterus and the intestinal tracts. Some women experience an urge to urinate more frequently.

How are Menstrual Cramps Diagnosed?

The diagnosis of menstrual cramps is usually made by the woman herself, and reflects her individual perception of pain once a woman has experienced menstrual cramps, usually with the adolescent onset of her monthly flow, she becomes well aware of the typical symptoms if there are other medical conditions contributing to menstrual cramps (secondary dysuenorrhea), the doctor may suggest diagnostic testing including imaging studies.

What is the Treatment for Menstrual Cramps?

Currently recommendation includes not only adequate rest and sleep but also regular exercise (walking). Some women find that abdominal message, yoga, or orgasmic sexual activity may bring relief. A heating pad applied to the abdominal area may relieve the pain and congestion and decrease the symptoms.
A number of non prescription drugs can help to control the pain as well as actually prevent the menstrual cramps themselves. For mild cramps, aspirin or paracetamol may be sufficient.
The main agent for treating moderate cramps are the non steroidal anti inflawattun of prostaglandins and lessen the effects. Such NSAIDS include ibuprofen, naproxen, ketoprofen.
A woman should start taking this medications before her pains becomes difficult to control. This might mean starting the medications 1 to 2 days before her period is due to begin and continue the medication 1-2 days into her period. The best results are obtained by taking the NSAIDs on a scheduled basis and not waiting for the pain to begin.

What if Cramps are very Severe?

If a woman’s menstrual cramps are too severe to be managed by the above strategies, then the oral contraceptive pills containing oestrogen and progesterone in a regular or extended cycle can be prescribed.
This type of approach can prevent ovulation which in turn reduces the severity of cramping and causes a light menstrual flow.
The use of intrauterine device that releases small amounts of progesterone directly into the uterine cavity has also been associated with a 50% reduction in the prevalence of menstrual cramps, in contrast, intrauterine devise that contains only copper may worsen the menstrual cramps.

Are there Surgical Solutions?

In the past, many women with menstrual cramps had an operation known as D&C to remove some of the lining of the uterus, some women even resort to the ultimate solution to menstrual problems by having a hysterectomy surgery that removes the entire uterus.

What is Treatment of Secondary dysmenorrhea

The treatment of secondary dysmenorrhea depends on the cause. There are a number of under of underlying conditions which can contribute to the pain, including endometriosis, uterine fibroids, adenonuyosis, PID, adhesions, use of intrauterine contraceptive devises (IUCD)
All of these conditions should be first diagnosed by the gynaecologist who will then recommend the optimal treatment.
If a woman notices changes in the severity of her menstrual cramps, the timing, or location, she should consult her gynaecologist especially if the changes are of sudden onset.

Prognosis for menstrual cramps

In general, a woman’s menstrual cramps do not worsen during her lifetime, infact the menstrual cramps usually diminish with age and after pregnancy.
Where there is secondary dysmenorrhea with an underlying condition contributing to the pain, the prognosis depends on the successful treatment of the underlying condition.