- Have you experienced pain during your periods??
- Are you missing on workdays due to your monthly cycles??
- Is it normal?
- Do you need to seek a doctor?
Here is a brief description of the common ailment of women.
- Dysmenorrhoea refers to cyclic pain or discomfort in the pelvic region during menstruation.
Here are a few terms associated with dysmenorrhoea:
- Primary dysmenorrhoea implies the pelvic pain that occurs without a pelvic disease.
- Secondary dysmenorrhoea implies the pelvic pain associated with certain underlying pelvic pathology e.g. fibroid, endometriosis, adenomyosis, IUCD, or Pelvic inflammatory disease.
- Spasmodic dysmenorrhoea is primary dysmenorrhoea, i.e. cramping pains, generally most pronounced on the first two days of menstruation.
- Congestive dysmenorrhoea is secondary dysmenorrhoea and pelvic discomfort begins a few days before menses but disappears rapidly thereafter.
In the second half of the menstrual cycle, with a drop of hormone (progesterone) levels, there is an increase in activity of certain enzymes, which results in the release of prostaglandins. These in turn, increase uterine tone and contractions resulting in pain and related symptoms.
The mechanism of pain in secondary dysmenorrhoea depends on the underlying cause.
CLINICAL FEATURES
- Dysmenorrhoea is characterized by crampy pelvic pain during menstruation that may be felt in the lower abdomen, lower back, or thighs.
- Other symptoms that may accompany pain include nausea, vomiting, loose stools, fatigue, fever, headache or light-headedness.
- Pain may be relieved by abdominal massage, counter-pressure, or movement of the body.
- In secondary dysmenorrhoea, pain may not be limited to menstruation and generally tends to worsen with time.
DIAGNOSIS
Diagnosis of primary dysmenorrhoea is based on the history of cyclical pain with the exclusion of any pelvic pathology.
The diagnosis of secondary dysmenorrhoea requires:
- review of a pain diary
- Pelvic examination
- USG examination
- Laparoscopy or hysteroscopy or both.
- During a pelvic examination, the size, shape, and mobility of the uterus; the size and tenderness of surrounding structures are assessed.
- A complete blood count with an ESR and cervical culture for infection may be required (pelvic inflammatory disease).
TREATMENT
- Treatment of dysmenorrhoea includes counseling, psychotherapy, lifestyle changes, medical measures, and surgical interventions.
- The treatment of secondary dysmenorrhoea is based on the underlying disorder.
- Medical measures aim to relieve pain and include commonly used pain killers.
- Oral contraceptive pills may be prescribed as they suppress ovulation, decrease menstrual flow and associated pain, regularize cycles and provide contraception also.
- Alternative therapies have been tried for refractory dysmenorrhoea.
- Surgery is indicated in cases that do not respond to medical or alternative therapies e.g. Hysteroscopy, Laparoscopy, or Laparotomy.
- The surgery may be helpful by removal of polyp, fibroid, adhesions, or removal of the chocolate cyst.
Acupuncture may be useful in certain patient groups.
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