Dysmenorrhoea is the pain experienced by a woman during her menstrual cycle. The menstrual cycle of every woman is associated with some pain in the lower abdomen, cramps in the legs, backache and general discomfort. If possible, majority of the women would like to stay back and rest during the 3 to 7 odd monthly days of menstruation.

The pain may be mild to severe and incapacitating. It may be sharp shooting or colicky or dull with sense of heaviness. There are invariably severe cramps in legs. Along with the pain, one may have associated sense of nausea, vomiting, sweating or giddiness

The duration of the pain varies. One may have pain during 1 or 2 days of the menstrual cycle or throughout the cycle till the vaginal bleeding lasts.

Actually due to hormonal changes, the uterus is prepared each month for receiving the fertilised ovum. For this purpose, blood vessels in wall of endometrium(inner layer of uterus) proliferate making it thick and soft. But when no fertilisation occurs, this newly formed vasculature is shed. In fact, the term ‘dysmenorrhoea’, is also described in some books as per the ancient meaning of the word as ‘cry of the uterus for lack of a baby’.

There is uterine contraction due to hormonal influence which contracts these blood vessels and also destroys the thickened endometrium. This causes release of prostaglandins and some other mediators of inflammation. All these factors contribute to the causation of pain during menses.

Dysmenorrhoea can be secondary to some problem in the uterus. Endometriosis, leiomyomas, other uterine tumors, pelvic congestion, pelvic inflammatory disease or intrauterine device are some of the causes for painful menstruation in women. In some cases there is no apparent cause for the pain. These cases are labelled as, ‘primary dysmenorrhoea’.

Primary dysmenorrhoea usually occurs in young girls about 15-16 years of age when the cycles become ovulatory. It may subside later in life with child bearing. But some women continue to have it even after delivering children.

Secondary dysmenorrhoea usually occurs later in life with an obvious underlying cause for the pain.

Diagnosis of dysmenorrhoea is fairly easy. Apart from the clinical examination, ultrasound of the pelvis helps in detecting or excluding certain conditions likely to cause that pain.

If there is an apparent cause for the painful menstruation, treatment of the cause cures it completely.

Primary dysmenorrhoea becomes a difficult condition for the sufferer. Since it is a regular feature, she cannot take off from her work every time. Many times, even family members tend to accuse her to be malingering.

Pain killers do provide relief, but also taking pain relieving pills very frequently is not good. They can cause gastritis and even kidney damage later on. Some women are given hormonal pills to help cure this condition but they are also associated with side effects.

Avoiding heavy food like fried things helps to avoid pre menstrual tension and also dysmenorrhoea. Taking adequate amount of fiber, iron and calcium in the diet helps a woman to overcome the pain of dysmenorrhoea to some extent. Acupressure, indigenous herbal preparations are also some of the non- pharmacological methods used to treat dysmenorrhoea. Regular physical exercise is beneficial.

Most important measure for a woman suffering from dysmenorrhoea is to, "accept”, the situation. She should be made to understand that she is made that way by nature and for few days every month she will suffer from pain and nothing much can be done about it. This acceptance will make her mentally carefree and automatically the perception of pain will also reduce.

Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital