PAINFORMATION: Menstrual problems

(First of 2 part series)

Most women are plagued every month with aches and pains that accompany their menstrual period. Aside from the mood swings, crankiness, and the other effects of hormonal fluctuations, there are a number of other menstrual problems encountered by the female populace.

There are a variety of menstrual or period problems. The more common ones include - Absent periods (Amenorrhea), Painful periods (Dysmenorrhea), Heavy and prolonged periods (Menorrhagia), Irregular periods, and Pre-menstrual Syndrome or PMS.

Amenorrhea or the absence of menstrual period - if your period never starts, it is called primary amenorrhea. If they cease to occur, it is known as secondary amenorrhea. The absence of menstrual period is normal - before puberty, during pregnancy and breastfeeding, after menopause. However, the absence of menstrual period may be caused by other factors, such as diseases of the ovaries or uterus(womb); disorders of hormone production involving the pituitary, adrenal, or other endocrine glands; psychiatric illness; emotional stress; drugs (like injectable contraceptives); surgical removal of the uterus (hysterectomy) and/or the ovaries; and many severe general illnesses (like chronic renal disease). It is best to see your doctor if your period stops suddenly for no apparent reason.

Dysmenorrhea or painful periods, are abdominal pains stemming from uterine cramps caused by spasms or contraction of the muscles of the uterus (womb). Known as primary dysmenorrhea, this condition is common among women, and has no underlying cause. Usually the pain starts on the first day of the period, and then slowly diminishes as the menses start to flow. Although the pain normally subsides after a day or two, it can get very severe while present. The pain in the lower abdomen may extend to the lower back and legs. The pain may consist of cramps that come and go, or a dull ache that is constant. Nausea, vomiting, headaches, and dizziness may also be experienced. Taking a warm bath or placing a hot water bottle over your abdomen may help relieve the pain. However, taking a pain reliever or analgesic may also be needed. Dr. Butch Manalastas, a trusted Obstetrician-Gynecologist, advises his patients to try a new class of pain reliever called coxibs (rofecoxib). Unlike the over-the-counter analgesics, coxibs (rofecoxib) can provide fast and effective pain relief without the gastro-intestinal problems usually associated with the traditional NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like ibuprofen, mefenamic acid, diclofenac, aspirin, naproxen, ketoprofen, etc., especially when these are used for extended periods of time.

Dr. Manalastas adds that it is important to determine if the abdominal pain is caused by a gynecological disorder or not. If the painful period is caused by an underlying gynecological disorder, it is referred to as secondary dysmenorrhea. The most common cause of secondary dysmenorrhea is endometriosis. Fibroids and adenomyosis (non-cancerous invasion of the muscular wall of the uterus by the uterine lining) are also known to cause secondary dysmenorrhea. The treatment of secondary dysmenorrhea would depend largely on the cause. Sometimes, surgery would be an option.

For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati, fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.