Upon entering puberty or just before; the bodies of both adolescent boys and girls undergo changes on their way to becoming full grown adults. These changes manifest differently for the sexes. Girls begin menstruating around this age, also called bleeding or a period. Menstruation normally occurs (for girls and in turn women) once every month and is a process that prepares their bodies for bearing children; this is called a menstrual cycle. In medical terms, menstruation occurs upon the uterus shedding its lining once every month, this is discharged through the vagina in the form of blood and some other material once every month; this monthly occurrence ends when women reach menopause (when the menstrual cycle stops) or is temporarily halted during pregnancy. Common symptoms which accompany menopause include bleeding, headaches, nauseation, bloating of the body, lower abdominal pain, fatigue, irregular mood shifts and even diarrhoea. Menstrual pain manifests primarily in the form of cramp and pain in the lower abdominal area, this pain can be felt even prior to the beginning of the menstrual cycle. The nature and level of menstrual pain can range anywhere from bearable and dull to acute and severely sharp; so much so that menstrual pain is the leading cause of women (under the age of thirty) being absent from daily activities like work or school; absenteeism.
Menstruation and its symptoms are usually manageable but at times they are not. Painful menstruation is known as Dysmenorrhea, of which there are two types; primary and secondary.
Primary dysmenorrhea is common menstrual cramps that are recurrent (come back) and are not due to other diseases. Secondary dysmenorrhea is pain that is caused by a disorder in the woman's reproductive organs, such as endometriosis, adenomyosis, uterine fibroids, or infection.
At times, the level of menstrual pain experienced varies from cycle to cycle, a host of factors may be causing these irregularities though it is at times just not possible to pin point an exact cause. Some women are at higher risk of suffering higher menstrual pain and the causes include
- If the menstrual cycle began before the age of eleven.
- Heavy flow of blood and other discharge menstruation, called a “heavy period”.
- Being overweight or obese, coupled with physical inactivity.
- Being a regular or heavy smoker, excess consumption of alcohol.
- A family history of heavy or/and painful menstruation.
- Irregular menstrual cycles
- Never having been pregnant is also a cause.
Apart from the potential causes stated above; certain pre-existent medical conditions can cause higher menstrual pain. These are in some way connected to a hormone called Prostaglandin, which is the trigger that causes muscular contractions in the uterus leading to discharge and shedding of the uterus’ lining. Prostaglandin levels rise before menstrual cycles begin, causing inflammation and pain. Some of these conditions are listed below.
- Premenstrual Cycle (or PMS) is a very commonly occurring condition among women brought about due to hormonal changes that the body of a woman undergoes a week or two before the beginning of a menstrual cycle. The symptoms abate upon the completion of the menstrual cycle.
- Endometriosis is a condition wherein the cells that are found along the lining of the uterus grow on other parts of the body like fallopian tubes, tissue surrounding the pelvis or on the ovaries. This condition is accompanied by heavy pain.
- Fibroids that develop within the uterus exert more pressure during menstruation and cause higher pain. These are non-cancerous and do not cause any particular symptoms.
- Pelvic Inflammatory Disease is an infection belonging to the uterus, fallopian tubes or ovaries. This can be caused due to bacteria that is sexually transmitted that causes inflammation and pain.
- Adenomyosis is a rare condition wherein the lining along the uterus grows “into” the muscular wall surrounding the uterus. This also exerts heavy pressure causing inflammation and pain and at times longer and heavier periods.
- Cervical stenosis is another rare condition wherein the cervix is naturally small and narrow. This leads to slower, longer discharge during menstruation and naturally more pressure build up. This aggravates pain inside the uterus.
- Polycystic Ovary Syndrome or more commonly called PCOS, a condition prevalent in one out of every five women, delays menstrual cycles (at times women even miss their periods) and in turn when menstruation occurs; it is painful and irregular. When menstruation does occur; ovaries basically release too many hormones and this causes pain. A lot of women have PCOS but do not recognise its symptoms.
In case debilitating pain occurs every month or three months straight, if periods are accompanied by diarrhoea and nausea, if blood clots are found in the discharge or the discharge itself smells foul. Meet your gynaecologist so that she can investigated and treat you according your problem.
Dr. Shilpa Ghosh
Director & Senior Consultant
Obstetrics & Gynaecology