Dysmenorrhoe is the medical term for severe period pain or menstrual cramps and it affects up to 50% of menstruating women, making normal everyday activities very difficult. Every month, the womb prepares itself to receive and hold a baby. This preparation involves the thickening of the inner lining of the womb, which also becomes well supplied with blood vessels. If no conception or pregnancy occurs for that month, this thickened womb-lining breaks down along with the blood and blood vessels in it and passes out through the vagina as the period or menses. The womb then starts the whole process all over again. The first menstruation in a girl's life is termed menarche while menopause refers to when menstruation ceases. This elaborate mechanism of menstruation is controlled by several hormones that are released into the blood at varied quantities at different times of the month. To help expel the menstrual products, the body, under the influence of these hormones, produces substances known as prostaglandins. These substances enable the womb to contract to expel its contents. During a normal period, the contraction of the womb causes little pain that is not disturbing. The pain of dysmenorrhoea is however disabling. These are primary dysmenorrhoea and secondary dysmenorrhoea. In primary dysmenorrhoea, there is no organic or psychological abnormality in the woman. It is primarily due to the over production of a particular type of prostaglandin which causes excessive contraction of the womb. When the womb contracts excessively blood supply to the ceIls of the waIl of the womb is cut off for a longer period. This injures the cells, which respond with pain to indicate that something is wrong. Primary dysmenorrhoea normally affects adolescent women; that is after menarche when the ovulatory cycle becomes established. The pain of primary dysmenorrhoea can be intermittent, or continuous, lasting for 1-3 days. It usually starts at the onset of bleeding and then subsiding over the next one or two days. The cramps and pain can be accompanied by headaches, dizziness, nausea and vomiting. The release of prostaglandins can also cause constipation and/or diarrhoea because of their effect on the smooth muscles of the intestines. Apart from severe stomach cramps, the pain can also extend into the lower back or into the thighs and legs. In secondary dysmenorrhoea, there is an abnormality or pathology in the pelvis of the woman. The pain of secondary dysmenorrhoea is similar to that of primary dysmenorrhoea, but it tends to affect older women. The pathologies whose presence cause secondary dysmenorrhoea include endometriosis; a disease in which some of the tissue lining the womb happens to be found else where in the body cavity. Pelvic inflammatory disease (PID), ovarian cysts, fibroids and sexual frustration are also well known causes. Dysmenorrhoea must be reported to the hospital or gynaecology unit for investigations, diagnosis and appropriate management. It is important that women monitor their menstrual cycle and symptoms in a diary for a couple of months so that you can give a detailed description of their menstrual pain. For example the woman should be able to tell the doctor how long her periods usually last, how regular her periods are and when pain occurs, how long she has suffered from painful periods and what type of pain it is, whether the blood loss has become heavier recently, whether blood loss includes clotting in the flow and whether the pain prevents her from carrying out her day-to-day activities. At the hospital, the doctor examines the patient with emphasis on the organs in the pelvis and lower abdomen. Tests done include blood and urine analysis as well as ultrasound scan of the abdomen and pelvis for abnormalities. Further tests may also be done. Treatment of dysmenorrhoea depends on the type. For secondary dysmenorrhoea, the underlying cause is identified and treated. Primary dysmenorrhoea is treated mostly by preventing the woman form ovulating in the first place by manipulating the hormone levels or by blocking the synthesis of prostaglandins in the body. The use of oral contraceptive pills is very effective at preventing primary dysmenorrhoea but it also prevents pregnancy. It is therefore not good for women who want a baby. There are several drugs that block the manufacture of prostaglandins in the body. They do this by inhibiting an enzyme called prostaglandin synthetase, which converts rapidly certain substances into prostaglandins. These drugs include the fenamates and some non-steroidal anti-inflammatory agents, which doctors will not hesitate to prescribe if a diagnosis is made. Primary dysmenorrhoea usually occurs during adolescence mainly between the ages of 17 and 25 years and the pain tends to lessen with age. With secondary dysmenorrhoea, if the underlying cause is identified and successfully treated, the symptoms should disappear. It is easier said than done but reducing stress levels can really be of help as it relaxes our muscles. Gentle exercise such as jogging and brisk walks can also be beneficial in reducing the pain of dysmenorrhoea. Old favourites include hot water bottles on the tummy. Some women prefer pain relief the natural way using magnetic treatment. Others have also tried herbal medicines, acupuncture or chiropractic. Source: The Chronicle