Her Monthly “Palava”

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Every woman has experienced cramping and pain around the abdomen during or before their periods. It might happen before your periods, as an unwelcome forewarning, or during your periods, leaving you tired and cranky until it's over.


Young girls usually experience cramping during the first few years after the onset of periods. As you grow older, these pains generally decrease in intensity and may disappear completely after the birth of your first child.


The cramps can be a monthly accompaniment to your periods or may occur rarely, and the pain from these cramps can be mild or severe. Emotional stress can increase the chances of you having cramps during your subsequent menstrual cycle.


The medical term for menstrual cramps is dysmenorrhea. Incidentally, dysmenorrhea is the most common reason of absence from school among adolescents.


Dysmenorrhea is of two types - one where the pain is only due to cyclical changes in your uterus as a part of your periods, or it may be due to disorders of your pelvic area. The pelvis is the part of your lower abdomen that houses your uterus, ovaries, cervix and vagina.


Why do they happen?


Every month, your uterus builds up a new lining of tissue, ready for lodgement of the fertilized egg. If the egg isn't fertilized, the lining is shed along with the unfertilized egg. When this occurs, certain molecules are released that may cause painful, intermittent contractions of the uterine muscles.


Current research proposes that menstrual cramps are a result of an increase in certain prostaglandins during your monthly cycles.


Prostaglandins are small compounds that may act to increase or decrease the size of blood vessels, and stimulate muscles to contract. In this case, these molecules cause blood vessels in the uterus to constrict, thereby decreasing blood flow to the uterus while causing prolonged muscular contractions in the uterus.


To supplement this, hormones produced by the pituitary gland (a small gland seated directly under the brain) causes the uterus to become more sensitive to prostaglandins during your periods.


Thus, some women whose reproductive organs are more sensitive to prostaglandins suffer from cramps that are much more painful than women whose organs are relatively insensitive to prostaglandins.


Certain factors may increase your risk of having painful cramps during periods:


- Early age at menarche (first period), usually if less than 12 years 

- Long menstrual cycles 

- Heavy flow 

- Smoking


In some cases, family history, obesity and even alcohol consumption have been linked to increased likelihood of suffering from menstrual cramps.


Diagnosis of dysmenorrhea usually relies on an explanation of symptoms by the woman herself. There are no tests routinely conducted to measure the contractions or pain.


Dysmenorrhea caused by other diseases of your reproductive organs may be due to a variety of conditions, including:


- Endometriosis 

- Ovarian cysts and tumours 

- Fibroids 

- Polyps 

- Pelvic inflammatory disease (PID) 

- Intra-uterine devices (IUD) 

- Anatomical abnormalities of the uterus (for example, your uterus may tilt backwards instead of lying forward)


It is essential to consult your doctor or pharmacist if the pain is not relieved by over the counter medications, progressively worsens or leaves you unable to get around with your routine activities. Initially, the clinician may perform an ultrasonography if a pelvic disease is suspected.


Symptoms


You may already know how it feels, but commonly, most women experience the following:


- Aching or gripping pain in your lower abdomen, which may radiate to your inner thighs, back 

- Fullness, pressure or bloating of the belly 

- If severe, vomiting and nausea 

- Loose stools or constipation


Managing dysmenorrhea


Over the counter drugs such as piroxicam, ibuprofens, naproxen or other analgesics can relieve mild dysmenorrhea.


Placing a hot water bag or bottle can also help in relieving the intensity of the pain.


Regular exercise releases endorphins, and may help in alleviating painful menstrual cramps in the long run.


Additionally, you can do the following to decrease the severity of the cramps:


- Avoid caffeine, alcohol or smoking 

- Massage you lower back and abdomen 

- Rest as and when needed


If these measures do not relieve the pain and the cramps are unusual or severe, you can consult the doctor who can advise additional drugs such as oral contraceptive pills or prescription-grade analgesics. He or she may also advise a thorough pelvic exam to check the condition of your vagina, cervix and uterus to ensure there are no abnormalities. A small sample of your vaginal fluid may also be taken if necessary.


If the cramps aren't due to your periods, proper treatment must be taken because most causes of dysmenorrhea are treatable by medical therapy.





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