Every month, most women worry about painful menstruation periods that steal their joy and peace but very few have any idea about the cause of such pain or even how it can be stopped since it is something that happens before or after their monthly periods.

Each woman is hurt in different ways. Some have terrible cramps, while the pain is mild for others. Most women even go for medication and checkups, but others regard the pain normal so they face it until it is gone.

Menstrual cramps are sharp pains in a women’s lower abdomen that commence when menstrual periods start and may continue for two to three days.

Doreen Tumusiime, a resident of Kicukiro in Kigali, for example, narrates that every month it is a rough time for her since her periods are so painful that she can hardly sit upright or even stand normally on the first day of her periods.

"My periods take five days but the first two days are so horrible. I vomit, completely lose my appetite and I feel sickly. I drink a lot of water and black tea that somehow help the pain reduce, she says, adding that after the first two days the pain disappears and she feels normal again.

According to Dr Rachna Pande, an internal medicine specialist, painful cramps during menstruation (dysmenorrhoea), affect 25 per cent of women the world over and those in late teens or early twenties are commonly affected.

"Dysmenorrhoea is said to subside after first child birth. Pain usually occurs as pain in legs, lower back but also some women experience nausea or vomiting along with the pain,” she says.

What causes painful menstrual periods?

Pande says the exact cause is not known, but it is postulated to be due to hormonal changes happening during menstruation after ovulation as new blood vessels are formed in the inner lining of the uterus to receive the fertilised egg.

"If conception does not occur, these blood vessels break down causing bleeding. Prostaglandins are released due to the breakdown of blood vessels, which cause release of mediators of inflammation. These may also cause pain,” she explains.

Dr Stephen Rulisa, a gynecologist and obstetrician at Teaching Hospital Kigali, says cramps are caused by uterine contraction during menstruation with inhibited blood flow to the wall that may cause pain.

He says cramps are on-and off-like contractions that occur during menstruation and he advises women not to worry about them since they are normal.

How menstrual pain can be reduced?

Pande says dysmenorrhoea can be secondary to disease conditions of the uterus like endometriosis and pelvic infections among others. Here treatment of the underlying condition cures dysmenorrhoea as well.

She also says that primary dysmenorrhoea is diagnosed by excluding other underlying disease causes for this pain through clinical examination and pelvic ultrasound.

Pande says non-steroidal anti inflammatory drugs (NSAIDS) help to relieve moderate to severe pain, but hormonal treatments can be given for severe or persistent pain.

She also says herbal treatments like use of fenugreek and basil are also used to relieve the pain but scientific studies have not proven these to be beneficial.

"Similarly, vitamins like vitamin B1 and E are also used but are not backed by scientific studies. Hot fomentation of the back also helps in reducing the pain. Women who exercise regularly are known to suffer less from dysmenorrhoea,” Pande says.

Rulisa notes that if the pain is severe, women should use pain killers. However, he does not advise to use them for a long time but says that if the pain persists they should see a doctor (obstetrician gynecologist) to verify if there are no aggravating factors like endometriosis or uterine fibroids.

He also adds that physical exercises are healthy and help reduce menstrual cramps.

Advice to teenagers

Pande says adolescents and teenagers should be counseled about menstruation, as well as dysmenorrhoea so that they learn to accept pain for 2 -3 days and not bother about it.

"A diet rich in iron and calcium is advisable for teenagers because at this age demand of iron and calcium increases in body. If it is not met, one can suffer from chronic anaemia, as well as joint and backache.”