Painful Periods is most common during menstruation. A ‘period’ is the term used to describe menstruation – the regular flow of blood from a woman which marks the beginning of a new reproductive cycle in her body. During the cycle, the womb (uterus) prepares to receive a fertilized egg by growing thicker and developing new blood vessels.
The uterus is covered or lined with a soft coating called the endometrium, which actually has two layers, called the basal layer and the functional layer; like a grassy lawn with plants which have roots (basal layer) and shoots (functional layer).
It becomes thickened in preparation to receive a fertilized egg, under the influence of the female hormones. If fertilization does not occur, the amounts of the hormone begin to drop steadily, and so the thickening process is slowed down. As the hormones reach their lowest level, the functional layer begins to shed because there’s no more support. When the cells are broken down, they release some chemicals that make the body of the uterus to start to contract/tighten.
This does two things:
The blood supply to the endometrium is cut off and so more of it dies and is shed
The uterus squeezes out all the blood and the endometrium that was shed. By the time the lining is shed, a new cycle has begun and the level of the hormones begin to rise again, and so the functional layer starts to grow back.
Why Painful Periods? These two actions (cutting off of blood supply and the contractions) can cause women to experience pain during menstruation – this is called primary dysmenorrhoea and is the most common, occurring in more than 50% of women. This type usually gets better as one grows older and for some people, improves after delivery.
Pain is the most common complaint during menstruation. This pain occurs in the lower abdomen and usually starts on the first day of the period, is worse on the first one to three days, and gests better after that. Painful periods, in medical terms, is called dysmenorrhoea.
Some other symptoms you might feel are low back pain, nausea, vomiting, diarrhoea, irritability, dizziness, moodiness, headaches.
There are two types of dysmenorrhoea –
Primary dysmenorrhoea: Usually starts at the onset or a few months after the onset of menstruation, and is normal.
Secondary dysmenorrhoea – This is when painful periods start in a woman who never used to have pain before. The pain is caused by a problem within the female reproductive organs, and it is more likely to start earlier in the cycle and last longer than in primary dysmenorrhoea. The things that can cause secondary dysmenorrhoea are:
Endometriosis: This is a condition in which the lining of the womb is found in other places outside the uterus, like on the pelvic wall, the ovaries, and the intestines. Endometrial tissue that is found outside the uterus is influenced by the female hormones, the same as inside the uterus. So, the tissue thickens during the cycle and is shed when menstruation begins. It is unable to flow out, and so it remains there and irritates the surrounding areas. This pain is usually severe, starts some days before the period starts, and continues for some days after the period has ended. The pain sometimes extends from the lower abdomen to the back and thighs. There can be cyclical pain in other parts of the body like on the skin or the chest. Other symptoms include cyclical diarrhoea or constipation, pain on stooling or urinating, painful intercourse, and infertility. It can also cause a type of ovarian cyst called an endometrioma.
Adenomyosis: This is similar to endometriosis, where there is endometrium found in other places. However, here, the endometrium is found within the muscle of the wall of the uterus. It either appears as small deposits (like seeds), or it is diffuse, in which case it isn’t easily separable from the rest of the body of the uterus. It is another common cause of severe dysmenorrhoea, usually associated with heavy and prolonged bleeding, and a bloated feeling.
Fibroids: Fibroids are abnormal growths that occur in the uterus, which can cause periods to be heavier and more painful than usual. They can also cause pain in the abdomen or in the lower back.
These are the most common causes of secondary dysmenorrhoea. Some other things that can also cause painful periods are:
- Pelvic Inflammatory Disease (an infection of the female reproductive organs, usually caused by sexually transmitted infections)
- Cervical stenosis – Sometimes after one has had a surgical procedure, scar tissue can form and block the cervix, which is the opening of the uterus, thus preventing the blood from flowing out during menstruation. This can cause pain during periods, and is usually associated with either reduction in or absence of blood flow.
How can it be treated?
For most people, menstrual pain is something that is a cause for discomfort, but not necessarily a major discomfort. However, if the pain disturbs you significantly every month, if the pain and other symptoms are getting worse, or if you notice that you suddenly developed very painful cramps, you need to see a Gynaecologist.
Do not assume that it is a woman’s portion, or lot, or cross to bear, and so decide to remain in pain.
It also helps to track your periods (this might be difficult, if your periods are irregular), so that you can prepare.
- Lifestyle/Home remedies: Different things have been found to help different people; you would need to discover what words for you. They include Exercise (or activity), Rest, Heat (using a hot water bottle, or soaking in a hot bath). The key is to find what works for you, that you can fit into your daily schedule or routine.
- Pain relievers: For most people, the use of easily available pain medications are enough to relieve the pain, on those two or three days when the pain is experienced. This is sufficient for primary dysmenorrhoea in
- Hormonal medications: For the treatment of endometriosis and adenomyosis, hormones can be given to disrupt the normal cyclical release of the hormones oestrogen and progesterone. This prevents the endometrium from growing and shedding both within and outside of the lining. The contraceptives can be in the form of pills, injections, and even intrauterine devices. This treatment is not permanent, but can provide relief from the pain
- Laparoscopy: This is a surgery in which the inside of the abdomen is accessed by the use of small, thin, instruments which are connected to a camera, and a monitor or screen. The endometrial patches and spots are identified and removed. This is the definite treatment for endometriosis. Laparoscopy can also be used to treat one of the complications of PID, which is the formation of scar tissue (called adhesions) in the pelvis.
- Hysteroscopy: For fibroids that are located on the inside of the womb, they are removed by the use of hysteroscopy, which is surgery that is done using a small instrument that is passed into the uterus and connected to a camera. There is no need to make a cut on the abdomen in this case. Hysteroscopy is also used to treat cervical stenosis.
- Surgery: An open surgery can be necessary, especially in the treatment of adenomyosis, to remove the parts of the wall of the uterus that has been penetrated by the endometrium. One might also need an open surgery to remove uterine fibroids.
It is important to seek a doctor’s advice if you develop painful periods. This will help to make an early diagnosis, so that if there is a need for intervention, it can be done in time.