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Painful Menstrual cramps

  • 4 minutes, 25 seconds
  • Womens Health
  • 2022-04-21

Estimated read time is 4 minutes, 25 seconds

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Painful menstruation is also known as dysmenorrhea and can be divided into two categories which are; primary and secondary dysmenorrhea. Primary dysmenorrhea is a type that occurs without any pelvic problems or disease and secondary dysmenorrhea occurs in presence of identifiable disease.

Dysmenorrhea affects about 45–95 percent of women of reproductive age and some evidence purports that it improves after childbirth and increasing age.

What causes painful menstrual cramps? 

This is a question that most ladies will ask themselves at some point in life. Nobody looks forward to that time of the month when you have to deal with, mild cramps, bloating, and irritability, it is never fun. 

However, experiencing crippling menstrual pains, heavy bleeding, fatigue, mood swings and other symptoms that affect your quality of life is not normal. Women who have a condition known as endometriosis find it very unbearable to deal with this kind of pain and for most of them it is debilitating.

Normally, during the menstrual cycle, the inner lining of your uterus known as the endometrium builds up and is then shed. And, well, you know what happens then. In ladies suffering from endometriosis, the cells of the endometrium grow outside the uterus, usually around the ovaries or beneath the uterus in an area called the posterior cul-de-sac area.

As this tissue builds up and sheds, it causes small amounts of bleeding inside the pelvic cavity which eventually causes pain, inflammation, swelling, and scarring

Remember, if your menstrual periods are causing you significant pain, you need to consult your doctor or gynecologist, because this may be a sign of Endometriosis. 

Listed below are the common conditions that are known to cause painful menstrual cramps.

Causes of painful menstrual cramps

1. Endometriosis - Endometriosis is the presence of endometrium-like tissue found outside of the uterus on other structures throughout the pelvis, including the ovaries, fallopian tubes, bladder, pelvic floor, and in more severe cases, the bowel, diaphragm, liver, lungs, and even the brain.

2. Adenomyosis- This is an invasion of the myometrium by uterine adrenal glands. It is a rare disease and can resemble uterine leiomyomas. Adenomyosis is like endometriosis, except instead of the endometrium implanting itself outside of the uterus, it is found embedded deep within the uterine muscle.  This is usually seen in women over age 30 who have already had children.

3. Fibroids/uterine leiomyoma- Uterine leiomyomata or fibroids are benign tumors of the uterine musculature that are a common cause of painful menstrual bleeding because they enlarge when stimulated by estrogen. They can range in size from microscopic to large enough to distort the shape of the uterus.

4. Ovarian cysts 

5. Intrauterine contraceptive device- IUCDs may cause bladder or uterine perforation or infection if inserted septically. A copper IUD is known to control that can prevent pregnancy for up to 10 years. It is usually placed in the uterus by a licensed healthcare provider and works by continuously releasing copper, which immobilizes sperm and prevents egg implantation. “A copper IUD, as opposed to a progestin IUD, can make menses heavier and more painful, particularly in the first few cycles after insertion,”

6. Congenital malformation of the uterus

7. Pelvic inflammatory disease- This is an infection of the uterus and fallopian tubes, with or without ovarian involvement. It is an ascending infection that develops during or immediately after menses; if it is chronic, then it can lead to dysmenorrhea. The most common causes are Chlamydia and gonorrhea. In short, it is most commonly caused by untreated sexually transmitted infections. Left untreated, PID can cause inflammation, scarring, painful menstrual cramps, and infertility.

8. Cervical stenosis and occlusion

Risk factors

The following risk factors are associated with more severe episodes of dysmenorrhea :

  1. Earlier age at menarche (Less than 12 years)
  2. Long menstrual periods
  3. Heavy menstrual flow
  4. Cigarette smoking
  5. Nulliparity
  6. Obesity
  7. Positive family history
  8. Some studies have found obesity and alcohol consumption to be associated with dysmenorrhea. 

Management and treatment

Treatment of dysmenorrhea/painful menstrual bleeding is aimed at providing symptomatic relief as well as inhibiting the underlying processes that cause it.

Many ladies are known to never seek medical attention for this condition and they opt for self-medication with analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) and direct application of heat are common effective strategies.

To date, the use of these medications is the most reliable and effective treatment for it. Because the pain results from uterine vasoconstriction, anoxia, and contractions that are mediated by prostaglandins, symptomatic relief can often be obtained by using agents that inhibit prostaglandin synthesis and possess anti-inflammatory and analgesic properties.

NSAIDs and combined hormonal contraceptives are the most commonly used modalities for the management of primary dysmenorrhea.  

Treatment of secondary dysmenorrhea involves correction of the underlying organic cause. Specific measures either medical or surgical may be required to treat pelvic pathologic conditions such as endometriosis and to ameliorate the associated dysmenorrhea. Periodic use of analgesic agents as adjunctive therapy may be beneficial.

Primary dysmenorrhea occurs at some point in almost half of all menstruating women. According to the American Congress of Obstetricians and Gynecologists, these cramps are caused by increased or imbalanced levels of prostaglandins — hormone-like fatty acids that stimulate the uterus to contract during the period. Changes in prostaglandin levels can cause more intense and frequent uterine contractions, compressing nearby blood vessels and cutting off oxygen to the uterus, thus causing painful cramps and discomfort.

    Verywell Health, 10 Teachers in gynecology, Emedicine, John Hopkins hospital site

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