Explore why period pain may not be 'normal' with Meri Sehat. Learn about potential causes, symptoms, and when to seek medical advice

When Period Pain Isn’t ‘Normal’

Severe menstrual pain may be common but it’s not normal and usually indicates a serious underlying issue. Read on to know what you should do and what it could be.

Overview

More than half of all menstruating women experience some pain during the first three days of their period. However, for some women this pain can be extremely severe, to the point of being debilitating and can hinder activities in their daily life. It is also accompanied by other uncomfortable symptoms such as diarrhoea, nausea, vomiting, headaches and <a href="https://merisehat.pk/disease/dizziness">dizziness</a>. 
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Painful periods are called &lsquo;dysmenorrhea&rsquo; which can be of two different types: primary and secondary dysmenorrhea.

<ul>
	<li>Primary Dysmenorrhea is the cramp-like pain that you feel before or during your period and is mostly a natural phenomenon as the muscles and blood vessels in your uterus contract. 
	This process is mediated by chemicals called &lsquo;prostaglandins&rsquo; that are naturally high during the first two days of your period and are made by the lining of your uterus. As the uterine lining is shed, the level of these chemicals goes down and hence the pain goes away. 
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	<li>Secondary&nbsp;Dysmenorrhea on the other hand is because of any disorder related to the reproductive organs. This is the kind of severe pain that raises red flags. The pain not only begins a few days before your period starts but it progressively gets worse throughout your period, not going away even after your period ends in much severe cases. 
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</ul>

Causes Secondary Dysmenorrhea

<ul>
	<li>Endometriosis: the inside of your uterus is lined by endometrium. When this specific tissue is found in places other than your uterus, we call this phenomenon endometriosis. This rogue endometrium can be found anywhere from your ovaries to fallopian tubes or bladder and even lungs. When you are menstruating, this endometrium also undergoes the same process as the one lining your uterus and will shed and bleed. This is what causes the severe pain and can lead to formation of scars and adhesions. These adhesions can cause the organs to stick together that leads to worsening pain. 
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	<li>Fibroids: these are growths of smooth muscles that can form anywhere in your uterus and can be big enough to distort the uterine cavity and cause pressure symptoms including pain. 
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	<li>Adenomyosis: this is essentially the endometriosis of the uterus. The endometrial lining invades the muscular portion of your uterus and can cause severe pain. 
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	<li>Other Causes: certain congenital problems of the reproductive tract can also lead to pain and so can other conditions such as Crohn&rsquo;s disease. 
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</ul>

Now that you can recognise which pain is normal and which is out of the ordinary you can easily ascertain which category you fall in. If you have the severe pain of secondary dysmenorrhea then this calls for an urgent visit to the gynaecologist&rsquo;s office. 

The first step is to let your gynaecologist know about your symptoms. Depending on these, a pelvic exam will be arranged followed by an ultrasound exam and a laparoscopy in order to identify the exact pathology causing your symptoms. 
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Available Treatment Options

<ul>
	<li>Painkillers: The first step in the management of painful periods is always a painkiller, most likely an NSAID such as Ibuprofen. Other conservative treatment options include Vitamin B1 and magnesium supplements but the evidence of their effectiveness is mostly anecdotal and more research is needed to classify them as effective treatment. 
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	<li>Exercise: can also be recommended, especially aerobic workouts such as walking, jogging, swimming etc. The reason behind this is that exercise leads to production of pain-blocking chemicals in the body. 
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	<li>Heating Pads And Warm Baths can also help. The hormonal intrauterine device can also be used to treat extremely painful periods and comes with the added benefit of lighter periods and contraception. 
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	<li>Birth Control: If the physical exam and laparoscopy point towards a more sinister aetiology behind your pain such as endometriosis then birth control methods such as the pill, implants, injections or hormonal intrauterine device can be used. Certain medications such as GnRH analogues can also help relieve the pain of endometriosis but come with side effects such as loss of bone mass and vaginal dryness. 
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	<li>Uterine Artery Embolisation: For fibroids and adenomyosis, the first step is medication followed by birth control methods and GnRH analogues. If all else fails then uterine artery embolisation is carried out which means the blood vessel to the uterus will be blocked. This stops the fibroid mass from growing any further and can help you have normal periods. In some women, periods may stop entirely. 
	&nbsp;</li>
	<li>Surgery: If all else fails, we opt for surgery. Surgery can be carried out in all three cases. For adenomyosis, hysterectomies may be done as this condition usually occurs in older women who have already undergone childbirth. Since endometriosis can return even after surgical removal, hormonal birth control should be continued afterwards. 
	&nbsp;</li>
</ul>

Conclusion

Despite the blas&eacute; attitude we have about women&rsquo;s pain, it&rsquo;s certainly not normal to have extremely painful periods. If you or any woman you know is suffering from this and no home remedies or totkas have worked out so far then it might be time to visit a gynaecologist. It&rsquo;s better to be vigilant about these conditions early on as they can affect not just your reproductive health but your overall health in the long term. 
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