Menstrual Pain

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Menses, also known as monthly periods/the red visitor/kunyesha…is part and parcel of a woman’s life during her reproductive years. For a majority, it slides by without much inconvenience however for some it represents the dreaded time of the month when everything turns upside down characterized by severe pain in the lower abdomen which may also radiate to the lower back and thighs. In medical terms this is referred to as dysmenorrhea ie painful menses. It’s generally experienced a day or 2 before menses and during menses. It can be severe enough to affect ones quality of life to the point of missing school/classes, work absenteeism or even needing to make visits to the hospital for injectable pain killers as oral pain killers offer no relief. When menses become a nightmare due to the pain, it is necessary to seek medical attention. There could be an underlying cause which tends to vary with age and it is therefore important to have it investigated as well as managed to ensure your quality of life is not affected. What are some of the common causes of menstrual pain?

a) Uterine fibroids : These are non-cancerous (benign) growths of the uterine muscle. They lead various symptoms including painful and/or heavy menses.

b) Endometriosis : This is a condition where the inner lining of the uterus is found in other areas within the abdomen or rarely even distant sites such as the brain. It is characterized by pelvic pain (both dysmenorrhea and general pelvic pain) but may also cause painful intercourse, pain on defecation and rarely even seizures during menses

c) Adenomyosis  : More common in older women especially those who have had several children. Occurs when the inner lining of the uterus grows into the muscle tissue of the uterus. It leads to heavy and painful menses d) Pelvic inflammatory disease This is an infection of the female reproductive tract that may also lead to painful menses

e) Congenital abnormalities : An abnormality in the development of the reproductive system can also lead to painful menses typically right from the onset of puberty eg if the hymen is completely sealed from birth and the menses cannot flow out of the reproductive tract. Sometimes there’s no specific identifiable cause What are some of the treatment options? Avoid repeated self-medication and always check with your gynecologist for the correct advice. A doctor will need to review your history, carefully examine you and probably order a few tests. Various treatment options are available with some more specific to the underlying cause. They include;

1. Analgesics : These are pain killers which vary in strength and recommended for you depending on the severity of pain experienced. Include medications like ibuprofen, buscopan, mefenaic acid, paracetamol, etc

2. Oral contraceptive pills : One of the non-contraceptive benefits of the contraceptive pills is reduction in menstrual pain.

3. Other hormonal treatments : This are especially useful in control of symptoms in conditions like endometriosis. Include options like progesterones as well as medications shut down the menstrual cycle (Gonadotropin analogues). Newer agents like Visanne are also available

4. Surgery : Your doctor may give this as an option depending on your individual context. This includes: laparoscopy for endometriosis, myomectomy (removal of fibroids) or even hysterectomy (removal of the uterus).

5. Alternative therapies : For some women exercise may reduce their cramps and for others placing a hot water bottle on the lower tummy during menses may provide some relief.

By Dr. Christine Murungi,
Consultant Obstetrician Gynecologist,
Outspan Hospital

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