Dysmenorrhea: Perceptions and Practices.
Background: Dysmenorrhea is a common condition among adolescent girls and young menstruating women. It is painful contractions of uterine origin during menstruation, commonly known as menstrual cramps or period pain (De Sanctis V et al., 2016). Dysmenorrhea is one of the most common gynecological conditions in women regardless of age and nationality (Proctor M et al., 2004) that affects their quality of life during their reproductive years. The pain is caused by intense contractions in the uterus, sometimes so strong that pressure is exerted on the blood vessels in the surroundings, thereby cutting off oxygen supply to the uterus. This in turn results in a lot of pain and cramping (Burnett et al., 2015).
Dysmenorrhea is often underestimated and considered natural hence left under-treated by most women through their entire lives. It is difficult to determine the prevalence rate because a large section of the population suffers from it and the topic is always left undiscussed due to associated social taboo. Besides there are also different definitions of the condition i.e. what all it entails (Harlow SD et al., 1996). Dysmenorrhea if left untreated and ignored for long time may further cause female infertility problems (Rabinerson D et al., 2018).
Dysmenorrhea is further divided into 2 subcategories based on history and pelvic examination: primary and secondary. Primary dysmenorrhea occurs in the absence of pelvic pathology whereas secondary dysmenorrhea occurs in the presence of pelvic pathology (Harlow et al., 1996; Proctor et al., 2008). Primary dysmenorrhea routinely occurs 6 to 12 months following menarche, pain is usually experienced in the lower abdomen, is cramping in nature and may radiate to the back and inner thighs. It usually lasts from 8 to 72 hours and either accompanies menstrual flow or precedes it by a few hours (Iacovides et al., 2015). Secondary dysmenorrhea in contrast often occurs years after the onset of menarche and may arise as a new symptom when a woman is in her 30s or 40s. The pain is not consistently related to menstruation alone and may occur throughout the luteal phase of the menstruation (Dawood et al., 2006). Common causes of secondary dysmenorrhoea include endometriosis, fibroids (myomas), adenomyosis, endometrial polyps, pelvic inflammatory disease and the use of intrauterine contraceptive device (Proctor et al.,2006).
The most important cause of primary dysmenorrhoea is thought to be excessive secretion of prostanoids. These induce uterine contractions, thereby reducing uterine blood flow leading to hypoxia and pain. The symptoms accompanying primary dysmenorrhoea, i.e. nausea, vomiting and diarrhoea are typical of prostaglandin adverse effects. Symptoms of primary dysmenorrhea also include severe pain in the thighs & lower abdominal region, fatigue & headache while those of secondary dysmenorrhea are irregular bleeding patterns, heavy periods, vaginal discharge, dyspareunia and severe pain in the abdominal region.
Diagnosis of dysmenorrhea is based on clinical history and physical examination. A pelvic examination and or transvaginal/rectovaginal ultrasonography is performed in all sexually active patients with dysmenorrhea as well as in those with suspected endometriosis. Other important investigations to be taken into consideration are urinary human chorionic gonadotropin pregnancy test; vaginal and endocervical swabs, a complete blood count, erythrocyte sedimentation rate and urine analysis to diagnose the severity of dysmenorrhea. Cervical cytology should also be performed to rule out any malignancy (Amimi S et al., 2014). Proper examination and detailed investigation are important so as to rule out other invasive and non-invasive diseases causing lower abdominal pain such as ovarian cyst, ovarian cancer, endometriosis etc. (Saccardi et al., 2012).
Treatment and management of dysmenorrhea go hand in hand. Traditional methods to obtain relief are consumption of warm tea & coffee. Additionally, a large number of non-steroidal anti-inflammatory drugs (NSAIDs) have been compared with placebo in terms of their effectiveness in relieving menstrual pain (Rabinerson D et al., 2018). Massaging the lower back and abdomen, placing a heating pad over the affected area and adequate rest are helpful in dealing with the pain. It is always recommended to undergo treatment under medical advice to avoid confusing dysmenorrhea from some other condition in disguise.
Dysmenorrhea can be prevented and managed just by following some healthy habits like getting good exercise, enough sleep, rest and relaxation. Caffeine, alcohol and smoking should be avoided. It has been found the women on contraceptive medication experience less pain. However, such medication should only be taken under medical supervision.
Appropriate counselling and management should be instituted among female students to help them cope with the challenges of dysmenorrhea. Information, education and support should also be extended to parents, peers and leaders at school and hostel administrators in order to address the reproductive health needs of the female students (De Sanctis V et al., 2016).
Ayushi Sharma, M.Sc (Biotechnology), GLA University, Mathura, Uttar Pradesh, India.
March 28, 2020
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Dr. Saima Khan, Ph.D