Dear Readers,

Tiana is a 21-year-old cashier, who works with a fast-food chain in St Catherine. She suffers, every month, from painful menstrual cramps. She dreads her periods and, sometimes, is unable to attend work because of the pain. She has used many over-the-counter and prescribed pain medications, which helps, sometimes, but the first two to three days of the period she usually experiences "really bad cramps".

She asked Lifeline for advice as she has been told that taking an oral contraceptive pill, monthly, can lessen the pain. She has avoided using birth-control pills, up to now, because of the weight gain she has heard it will cause, but she is considering using it now.

Menstruation refers to a monthly occurrence, involving blood loss, experienced by most females of child-bearing age. The lining of the uterus (womb) is shed and the material passes through the small cervical opening and out through the vagina. Some pain and discomfort at this time is normal, but when the individual has to miss out on work, fairly often, investigations should be undertaken to ensure no underlying treatable medical disorder is present.

Painful menstrual cramps are referred to medically as dysmenorrhea. dysmenorrhea can be primary, in an otherwise healthy woman, or secondary, when underlying conditions are also occurring in the uterus and/or pelvic organs.

Menstrual cramps have the following characteristics:

They are periodic pelvic and abdominal pains accompanying monthly blood loss

More than 50 per cent of all menstruating women experience cramps

Primary dysmenorrhea refers to regular menstrual cramps which occur without underlying disease

Secondary dysmenorrhea involves some abnormality in the pelvis or the female reproductive system

Physical exercise may help alleviate the intensity of menstrual cramps

Menstrual cramps improve with age

Female are more likely to experience menstrual cramps if:

They started puberty at age 11 or younger

If bleeding is heavy

If the person experiences irregular menstruation

If the female is nulliparous (never given birth)

If there is a family history of dysmenorrhea

If the female smokes

Menstrual cramps occur because, ,when menstruation takes place, the body releases prostaglandins (hormones) which cause the uterine muscles (and blood vessels) to contract, constricting blood supply to the inner lining.

This prevents oxygen from reaching the womb's internal lining (endometrium), which breaks down due to tissue death, and is shed.

The contractions continue as they force the shed tissues with blood out of the uterus, via the cervix. The stretching of a small cervical os (entrance to cervix), as the shed material passes out, is thought, also, to be a painful process for some women. The prostaglandins stimulate the womb contractions and also cause pain at this time.

This occurs in a normal female. Sometimes the discomfort experienced by this process is increased by the presence of other diseases or disorders in the pelvis. These "other" factors result in pain referred to as "secondary dysmenorrhea".

Secondary dysmenorrhea can be caused by the presence of some of the following disorders:

Endometriosis where the inner lining tissue of the uterus is present in other parts of the pelvis or even at distant sites. At menstruation they too bleed and can cause scar tissues and tissue adhesions to form. The blood itself also acts as an irritant to local tissues.

Uterine fibroids can distort the size of the uterus and cause menstrual pain.

Pelvic Inflammatory Disease (PID) which usually occurs after contracting sexually transmitted infections (STI's).

Cervical stenosis (narrowing of the mouth of the cervix (cervical os)

Adenomyosis where there is abnormal growth of the uterine lining which penetrates into the uterine muscle.

Use of Intra uterine contraceptive devices in some people.

Uterine retroversion (abnormal positioning of the uterus)

When menstruation is very painful and precludes attending work, school or other regular functioning, then a physician's help should be sought to examine, investigate and determine if secondary causes for the painful menstruation exist.

In normal females the difference in pain levels experienced is also thought to be related to the amount of prostaglandin hormones which are produced. Women who have elevated levels of prostaglandins often experience more painful cramps at menstruation than other females.

Other factors which increase menstrual pain include:

Lack of exercise

Emotional stress

Symptoms accompanying menstrual cramps include:

Throbbing pains to the lower abdomen, which may radiate to the legs and lower back

Headaches

Nausea

Vomiting

Constipation

Diarrhea

Dizziness

Many tried and true home remedies do work.

Take a warm bath

Apply a heated pad or towel to the abdominal wall and lower back

Massage the abdomen

Exercise

Eat light

Take vitamin B6 and B1, magnesium supplements and Omega-3 fatty acids.

Avoid caffeine, sugar, alcohol and salt.

Raise the legs or lie with bent knees

Take over-the-counter Brufen, Advil, Tylenol or Panadol. The main method of preventing moderate cramps is the use of non-steroidal anti-inflammatory drugs ( NSAIDS e.g. Advil), which are also anti-prostaglandin in effect and so move to counter the pain in a direct manner by targeting prostaglandin. It is best to begin using oral medications before the pain is established. medication, if usually needed, should be started one to two days before onset of menstruation, if possible and continued for at least two days for best results.

MEDICAL TREATMENT

Sometimes prescription-level NSAIDS, such as Cataflam, Voltaren, Ponstan, and Zerodol, selective Cox-2 inhibitors such as Arcoxia and anti-spasmodics, such as Baralgin, are required from a Physician. Narcotics and antidepressants are also used (rarely) when necessary.

If menstrual pain eludes control, even after trying the above methods, a female may be placed on Oral Contraceptive Pills (OCPs) for months or years. This prevents ovulation and reduces the level of prostaglandin production, therefore reduces the amount of cramps experienced. This method also tends to lessen menstrual flow.

For the treatment of secondary dysmenorrhea, the underlying root causes must be corrected by a physician. This may require the treatment of infections with antibiotics, or even surgery, in the presence of uterine fibroids.

Write to: LIFELINE,

PO BOX 1731,

KGN 8

AJM