Dear Doctor,I always get very painful cramps. I usually take ibuprofen or strong tea to soothe the pain but am told it’s not a health problem. What is the cause of these cramps and what should I do to avoid them or ease the pain??Nadine 24, KIST Student

-------------------------------------Dear Nadine,Painful cramps during the monthly menstrual cycle are part of the regular routine of   women during the reproductive years of their lives.  Some women have severe pain which is incapacitating, while some have tolerable pain.Technically, this pain is called dysmenorrhoea. If there is no other underlying cause for the pain, it is called primary dysmenorrhoea. Whereas if the pain occurs during menses, due to some other co existing pathology like endometriosis, it is called secondary dysmenorrhoea.  The meaning of this term we learnt as medical students is, "the cry of the uterus for lack of a baby”. Around ovulation, the uterus is prepared for conception and hosting a baby. For this purpose, the inner wall of the uterus thickens and new blood vessels are formed. When the ovum is not fertilised, this new build up gets destroyed. This entire process occurs as a balance of the 2 hormones, estrogen and progesterone.During shedding of the endometrial cells, there is release of prostaglandins and other chemical mediators of inflammation. These cause the uterus to contract causing pain. In some women, the contractility of the uterus is less, thus they experience mild to moderate pain. But with severe contractility comes severe pain. It is said that dysmenorrhoea stops or reduces after the first child, but this may not always happen.The pain is cramp like. It is commonly   located in the lower abdomen, thighs, legs and or lower back.  Some women may also have nausea, vomiting and headache along with the painful cramps in the legs.If the pain is tolerable, one should learn to, "live with it”. At times, an individual can get relief even just by bed rest for a few hours.  The pain though severe, subsides automatically in 2-3 days or at the most till menstruation lasts.  In case of severe pain, one can take pain relieving tablets like Ibuprofen, diclofenac, e.t.c.  But these tablets can cause burning pain in the abdomen, nausea, vomiting and even peptic ulcers as adverse effects. Taken repeatedly, they can damage the kidney. Hot compression of the lower abdomen and back during dysmenorrhoea is useful in reducing the pain as the muscles are relaxed after hot fomentation.Taking hot tea or coffee gives a sense of well being and also helps in easing the pain. Dysmenorrhoea is a physiological condition, hence the pain should not be considered as a disease. It should be accepted as part of, "womanhood”.