Dr. Duru Shah
MD FRCOG FCPS FICS FICOG FICMCH DGO DFP
Many young girls and women suffer from painful periods for which they take a pain- killer followed by relief, which allows them to carry on with their daily routine. On the other hand there are girls and women who suffer such excruciating pain every time they get their periods that they have to stay in bed with a hot water bottle, they keep vomiting and sometimes they faint! The medication they take just helps them for a few hours and then the pain comes back with a vengeance. Just because a girl is not married, she is told that this is normal and that the pain would go away once she is married! Even her doctor gives her the same answer!
So a young lady would have to go through her higher education and her career till she gets married for the pain to go! Or get married immediately, hoping that the pain would disappear! What has marriage got to do with the pain during periods? Why are we using such an outdated modality of relief for these unfortunate girls in this modern era where we can diagnose and treat so effectively? I see at least one young lady with painful periods every single day and in almost 80 % of them, this is what I hear. And I ask “Why did you not see me or any other gynaec for so many years? “The prompt answer from the mother is “I too had such pain during my periods and I think she has inherited it. Why get her used to taking tablets, it’s not good for her”
I am amazed to know that such lack of information exists even today and hence I was compelled to write this article. Painful periods can be due to various reasons; some of them being purely physiological and some pathological.
The Physiological reasons are:-
When a woman releases an egg which can potentially lead to a pregnancy, she may have a painful period, yet all women who ovulate, do not necessarily get painful periods. Such pain occurs almost every month and can be easily relieved by a tablet or two during the period of pain or it could be prevented by taking the oral contraceptive pill (OCP) which prevents ovulation and hence prevents the pain. As a matter of fact, we use these as a test - if the pain disappears with a pack of OC pills, then we can confidently tell a patient that her pain is due to a physiological process called “Ovulation” and then she is free to either prevent the pain, if severe with the OC pill, or if mild, to take pain killers during her periods. This makes her comfortable during periods and prevents her from looking at menstruation negatively.
In some women the cervix ie. the mouth of the uterus is very tight. This could give rise to some sort of pain as the menstrual blood is pushed out of the uterus. After a normal delivery, the mouth of the uterus, gets stretched to allow the baby to pass through, which helps to relieve the spasm. Following delivery, such pain disappears after a normal delivery, but not after a planned Caesarean delivery. Probably that is why the saying goes “The pain will disappear after you get married”.
Both the above are due to physiological processes of the body. But one must remember that pain which keeps increasing month after month is a pathological pain which is due to some abnormality within the pelvic.
The commonest reasons for such pain are:-
Fibroids, Endometriosis, Adenomyosis, Pelvic inflammatory disease
Fibroids: are benign tumors of the uterus which occur in almost 1 out of 4 women around 40 yrs of age. If they are present within the muscle or cavity of the uterus they can cause severe pain during periods. Removal of the fibroids gives instant relief.
Endometriosis & Adenomyosis: is a condition in which a woman besides bleeding through the vagina also bleeds within the muscle of the uterus and within the pelvis, every time she gets her period. The pressure of the blood building up inside the body, with no outlet to that blood, causes severe pain, which gets worse month after month. This condition is also associated with infertility as it causes the ovaries, tubes and uterus to get stuck together because of the blood discharged around them every month. Surgery is the best treatment option for these conditions though there could be temporary relief offered with specific medications, which control these diseases.
Pelvic Inflammatory Disease: is a condition which follows severe infection of the pelvis. It is a remnant of the infection which is either incompletely treated or not treated effectively or in good time. It leads to painful periods, infertility and painful intercourse. The treatment again is surgical for permanent relief.
I have only touched upon each of these diseases which cause painful periods and I feel that there is much more that I would like to discuss about each of these conditions. So, the next few issues, I hope to write more in detail on each one of these conditions.