One of the commonest problems women face will be painful periods (dysmenorrhoea). At its most severe, it can be debilitating. Most are however less so. Nonetheless, it can prove troublesome and may interfere sufficiently to warrant investigation and treatment.
Some common causes of period pain are:
For many there is an imbalance of the levels and types of hormone called Prostaglandins in the womb. This leads to pain developing. Most of the time this pain commences with the period or just before and quickly tapers off as the period progreses. Commonly thiss tarts early after the onset of mensturation. This is termed primary dysmenorrhoea.
Secondary dysmenorrhoea is more sinister. It happens later in life. Usually the earlier years of periods are not too bad. Then gradually, pain starts or worsens. This is more related to the presence of underlying conditions triggering the pain. Common conditions are endometriosis, fibroids, adenomyosis and so on
In others, blockage of the neck of the womb which slows down the outflow of blood or cometimes stops it completely also can cause pain. An example of this can be surgery on the neck of the womb. Endometrial ablation performed for heavy periods can lead to scarring and obstruction. Removal of part of the womb for example, cone biopsy or laser therapy for treatment of abnormal cells can also do the same.
When a woman presents with this problem, it is important to distinguish between primary or secondary dysmenorrhoea. The severity of the symptoms may mandate further investigations even in the case of primary dysmenorrhoea. Some of the investigations are:
- Pelvic ultrasound looking for fibroids, adenomyosis, severe endometriosis
- Blood testing to look for markers of endometriosis
- Laparoscopy to check the pelvis and exclude endometriosis.
Treatment will depend on the findings. For many it will be simple reassurance and the use of anti inflmmataory pain killers. For others, it may mean hormonal therapy like the Pill or even surgery, especially, if there is severe endometriosis or significant fibroids present. The therapy needs to be tailored to the individual and their age together with wish for fertility.
These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation.