Dysmenorrhoea- the low down on painful periods

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Dysmenorrhoea is a medical term for period pain that is bad enough to affect a woman’s usual daily activities. Sometimes I think non-sufferers don’t fully understand just how bad dysmenorrhoea can be.  As a GP I have seen women and girls reduced to total misery on a monthly basis- with fainting, vomiting, diarrhoea, and agonising abdominal and thigh pain. Often, even with bedrest, hot water bottles and painkillers, the symptoms for the first few days of a period can be almost unbearable. And then there is the depressing knowledge that this horror will return again and again.

Certain risk factors for dysmenorrhoea have been identified. It occurs less often in women who have had their children earlier in life, and in women who exercise more. It is more common in women whose periods start before the age of twelve, women who have a low body weight or who are obese, and in women who are smokers- especially girls who start smoking in their early teens.

So what can be done about it? Well, it’s important to see your doctor to exclude underlying causes- such as endometriosis, fibroids, adenomyosis or pelvic infection. There may be a need for a physical examination, testing for STIs (sexually transmitted infections), and sometimes a pelvic ultrasound scan.

To help with the pain, anti-inflammatories, also known as NSAIDs, are often a good place to start (assuming you have no contraindications to these meds- always check the patient information leaflet if unsure). These include Ibuprofen (Nurofen), Diclofenac (Voltaren) and Mefenamic acid (Ponstan). Mefenamic acid can reduce the heaviness of periods too. But here’s an important fact that a lot of women don’t know- anti-inflammatories will minimise pain only if they are taken very early in a period, or just prior to a period- before prostaglandins get a chance to form in the uterus (womb).

So, what are prostaglandins? Well, in dysmenorrhoea, the uterus works harder than normal to shed its lining and the resulting contractions lead to pain. The hormone-like compounds that cause these contractions are called prostaglandins. If you prevent prostaglandins forming in the first place, by taking an anti-inflammatory, the pain may be a lot less. However, once prostaglandins have formed, the “period genie” is well and truly out of the bottle, and the pain can be hard to reverse.

If you want to reduce period pain to a minimum, anti-inflammatories need to be in your system as soon as possible when the period begins, and ideally some hours beforehand. This may involve careful tracking of period patterns to stay one step ahead of the game each month- but it can be really worth it. Smartphone apps can be helpful with tracking, or just an old fashioned calendar!

The contraceptive pill or an intrauterine device such as the Mirena coil, can be helpful. These options obviously make sense if a woman also needs birth control, and are worth discussing with a GP.

So here are the take home messages- consider EARLY use of anti-inflammatories, try to exercise more, avoid smoking, maintain a healthy weight, and consult your doctor to exclude underlying problems, and perhaps to explore further treatment options.

by Dr Aifric Boylan

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