Dear Doctor,

My breasts really swell during my period and I get the worst cramps. I try to avoid work during those days but I have an inconsiderate boss. What can I do to make my ordeal more bearable?

Annet

Dear Annet,

Sorry to hear about your suffering and the boss being inconsiderate. But that is the bitter reality. Many women suffer from problems related to menstruation, which they cannot speak out openly, and others, particularly men, do not realise the pain she is undergoing.  Painful menstrual cramps and breast soreness is supposed to be the most common under reported and under treated health related problem.

Menstrual periods occur due to change in equilibrium of the two hormones estrogen and progesterone. The breast ducts enlarge due to effect of estrogen, whereas progesterone causes milk glands to swell.  Due to effect of both of these, breasts feel swollen and sore during or around periods.

Menstrual bleeding occurs due to contractions of the uterus, while its vascular inner lining is being broken and expelled.  Cramps occur due to these uterine contractions. In severe contractions, blood supply of the uterus may be affected, contributing to the pain. If any pelvic infection and inflammation is present, that also contributes to the pain.  Pain may occur due to infection of the inner lining of uterus itself or even due to presence of a tumour.  A woman may experience more pain, if she has some digestive problem like constipation, dyspepsia, and et cetera, some foods like fatty foods add to the pain and discomfort. Drinks like alcohol and sodas, tend to cause fluid retention and aggravate the pain.

The intensity of symptoms varies from one woman to another. Why some women suffer more and some less, is not known precisely. But it is said to depend on several factors; hormonal balance, young age, beginning of menses, and not having a baby, are some of them. In fact, it is said that sometimes just becoming pregnant and delivering a baby helps to rid of painful menstrual cramps. Use of hormonal contraceptive pill also causes pain to occur.  Genetic factor also exists. If somebody suffers from painful menstrual cramps, there would be definitely some close female blood relative with the same problem.

Mild pain can be relieved by hot compresses or using hot water bottle. In case of severe pain, over the counter pain killers are helpful. Massaging with essential oils is also said to be useful.

Cutting on salt in food, avoiding heavy food, avoiding alcohol, are other measures that help in reducing painful cramps.

 Dr. Rachna   Pande is a  specialist in internal medicine.