One day while attending an anatomy class, a girl suddenly fell on the ground and lost consciousness. After the emergency care and regaining alertness, she mentioned that she was on her periods and fainted because she was having severe menstrual pain. When offered medication, she refused saying that taking pills during menses negatively impacted women’s reproductive system. It is a pervasive myth in Asian countries associated with medication intake during periods, and educating women more about dysmenorrhea can end their suffering.
“Crampy lower abdominal pain radiating to the lower back or thighs during menstruation is known as dysmenorrhea”. Other symptoms include headache, nausea & GI discomfort such as vomiting, and loose stools. Symptoms usually decrease with aging or disappear, most likely after childbirth. About 16–90% of women suffer from Dysmenorrhea in their reproductive age, with 2–9% having severe pain. It is the primary cause of absence from school and work in childbearing age.
Dysmenorrhea is divided into primary and secondary types. Primary dysmenorrhea occurs in the absence of an underlying pathology & is a normal body response. In contrast, secondary dysmenorrhea occurs concomitant to a disease process such as endometriosis and adenomyosis or uterine fibroids. Secondary dysmenorrhea also comprises of painful intercourse, enlarged globular uterus, and non-responsiveness to initial treatments.
Treatment of primary dysmenorrhea depends on its effects on activities of daily living.
1. When menstruation is not painful, and daily activities are normal, no intervention is required.
2. When menstruation is painful and rarely inhibits regular chores, analgesics are seldom needed. However, non-pharmacologic interventions such as exercise and the application of heat packs can be used.
3. When daily living activities are compromised, analgesics such as acetaminophen or NSAIDs (Naproxen, mefenamic acid) become essential, which in the long term, prevent absence from school or work. When analgesics are ineffective, hormonal contraception becomes the next logical choice.
If your body does not respond to analgesics or hormonal contraception in 3–6 months, you should get evaluated for secondary dysmenorrhea by your doctor.
