Dysmenorrhoea

D ysmenorrhoea is defined as painful menstruation. It is the pain felt in your lower abdomen just before or during periods, produced by the contraction of your uterus. As part of the normal menstrual cycle, the uterus squeezes out the build-up of tissue inside when it does not receive a fertilized egg, which is witnessed in the form of bleeding. However, at times it can be a sign of an underlying disorder. Thus it is divided into two types:

1. Primary Dysmenorrhoea – is in the absence of organic disease. This is the commonly experienced ‘menstrual cramps’ which have a cyclic nature corresponding to monthly periods. The uterus is a muscular organ with blood vessels penetrating the walls. When it contracts so strongly that it temporarily blocks its own blood (and oxygen) supply, pain ensues.

Menstrual cramps usually get milder with age and after having a child. Thus, being under 30 years of age and never having been pregnant, are risk factors for dysmenorrhea. Additionally, smoking, alcohol intake during menses, having a family history, reaching puberty early (at or before 11 years of age), experiencing heavy and/or irregular bleeding during periods also increase your chances of painful menstruation.

2. Secondary Dysmenorrhoea – is pain acquired due to a medical disease of the reproductive system. Causes include:

• Endometriosis

• Adenomyosis (internal lining of uterus grows into its muscular wall)

• Uterine polyp

• Fibroids

• Ovarian cyst

• Cervical stenosis (small opening of cervix impeding outflow of blood)

• Pelvic Inflammatory disorder

• Copper IUD (a small wire like structure inserted into uterus for birth control)

• Abnormal pregnancy (miscarriage, ectopic )

When to seek expert advise

If your menstrual cramps started with your first period and subsequently occur every month, it is likely that there is nothing to worry about. However, it is recommended that you make an appointment with the medical faculty at the Women’s Health Care Service Line​ at The Aga Khan University Hospital if you notice:

• Such pain for the first time (not having felt it before with menses), especially after 25 years age

• Symptoms are getting worse

• Dealing with these complaints negatively affects your academic, professional or social life

• Painful intercourse

• Abnormal bleeding (heavy or irregular)

Certain causative disorders can lead to complications. Endometriosis may bring about infertility and pelvic inflammatory disease can cause internal scarring which raises the chances of ectopic pregnancy. Consequently, it is important to seek medical attention early for adequate treatment.

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