Menstrual pain refers to abdominal pain which precedes or occurs
during a woman's menstrual period. It is sometimes referred to as
menstrual cramps and usually occurs anytime from just after ovulation to
the end of menstruation. Menstrual pain is mostly located in the region
of the lower abdomen either centrally (suprapubic or umbilical) or on
the sides and may radiate to the thighs or lower back. The pain,
however, tends to subside as the menstrual flow gradually comes to an
end.
In the early part of the menstrual cycle a woman's body
gradually prepares itself for hosting a pregnancy by causing a
thickening of the inner lining of the womb. After ovulation, if
conception does not occur, this built-up inner lining of the womb is
shed and removed from the body through menstruation. During this process
the broken-down tissue of the inner lining release several chemical
compounds, including prostaglandins, which cause the muscular wall of
the womb to contract and this contraction helps to expel the shed tissue
from the womb through the vagina in form of menstrual flow. However,
this contraction also tends to constrict the blood vessels of the womb,
hence reducing the oxygen supply to the womb, and this results in the
cramp-like pain felt during menstruation. This process happens in every
woman who menstruates, hence many women usually experience some degree
of pain during their menstrual periods and this is not necessarily
abnormal. The good news is that menstrual pain tends to reduce with
increasing age and also with increasing number of children, i.e. the
older you get and the more children you have, the less the menstrual
pain becomes. However, when menstrual pain becomes excessive and
incapacitating, or interferes with a woman's daily activities, then it
becomes abnormal and is medically referred to as dysmenorrhea. Other
symptoms which could be associated with dysmenorrhea include nausea,
vomiting, change in bowel habit (diarrhea or constipation), headache,
dizziness, disorientation, fainting, fatigue, and hypersensitivity to
sound, light, smell and touch.
Now, dysmenorrhea (abnormally
excessive menstrual pain) can be classified into 2 types, primary and
secondary dysmenorrhea. The primary type refers to dysmenorrhea with no
known cause (i.e. a physical or psychogenic cause cannot be found for
the pain). The secondary type, however, can be caused by several medical
conditions including, but not limited to, the following:
- Pelvic inflammatory disease (PID)
- Sexually transmitted diseases (STD's)
- Fibroids
- Intrauterine Contraceptive Device (IUCD) made of copper
- Ovarian cysts
- Endometriosis
- Premenstrual syndrome (PMS)
- Stress and anxiety
Treatment of dysmenorrhea involves both pain management and specific therapies for any known cause.
Pain management includes:
- Drug therapy - the following types of drugs are known to be effective against menstrual pain
- Non-steroidal anti-inflammatory drugs (NSAID's) like ibuprofen, piroxicam, diclofenac, etc.
- Other prescription pain relievers (including narcotic drugs), such as pentazocine, tramadol, codeine, etc.
- Hormonal contraceptives (birth control pills)
- Non-drug therapy - the following non-drug home remedies have been reported to relieve or at least reduce menstrual pain in some women:
- drinking warm beverages
- taking warm showers or baths
- applying a heating pad over the lower abdomen, below the belly button
- doing light circular massage with the finger tips over the lower abdomen
- avoiding heavy meals (eating light but frequent)
- increasing intake of dietary fibres (taking more fruits, vegetables, whole grains, etc) and reducing intake of salt, sugar, alcohol and caffeine (coffee).
- keeping the legs elevated while lying down or lying on ones side with the knees bent
- practicing relaxation techniques such as meditation and yoga
- doing regular exercises, including pelvic rocking exercises
- controlling ones weight (losing weight if overweight)
Cause-specific therapies include all treatments aimed at resolving any of the causes of secondary dysmenorrhea such as
- Antibiotics, for instance in treatment of PID and STD's
- Surgery, e.g. for fibroids, ovarian cysts, etc
- Hormonal therapy, e.g. in treating endometriosis
- Anti-depressants, e.g. in the management of PMS
- Nutritional supplements, e.g. thiamine (vitamin B1), magnesium, vitamin E, zinc, omega-3 fatty acids, etc, have been shown to relieve or reduce menstrual pain, especially in primary dysmenorrhea. Thiamine, in particular, has been shown to provide a CURE, rather than mere pain suppression, in many women with primary dysmenorrhea.
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