Primary Dysmenorrhoea



What is Primary Dysmenorrhoea?

Primary Dysmenorrhoea is also known as spasmodic or true dysmenorrhoea. This is the most common form of severe period pain. It usually starts a year or two after the commencement of periods. It nearly always disappears spontaneously after 25 – 30 years of age and is usually at its peak between the ages of 15 and 20 years.

The pain always starts with the actual menstrual flow, never before. It may last for a few hours or even a day or more. It may be of considerable severity while it lasts. The pain is felt chiefly in the lower part of the abdomen. It often spreads to the inner parts of the thighs; there may be some low backache also. The patient may look drawn and pale, sweat profusely and feel very uncomfortable. Nausea and vomiting are fairly common, and sometimes the patient may faint. There is often discomfort with passing urine and with bowel actions; sometimes there is diarrhoea.



All sorts of medical explanations have been put forward over the years as to why this should suddenly put in an appearance in otherwise normal, healthy young women. Some claim the sudden alteration from an active, exercise-filled routine such as experienced in school or college to a more sedentary way of life is of particular importance and a causative factor. It strikes suddenly and without any obvious cause at an age when these variations are occurring, suggesting that physical activity (or the lack of it) may play a part.

Thousands of young women have been checked very carefully to discover if there is some underlying pathology. In most cases none can be found. The pelvic organs are perfectly normal and healthy. In some rare cases, heavy menstrual bleeding may produce clots, and in turn this can produce pain with the commencement of the flow, particularly if clots become jammed in the cervical canal.



Some women have an abnormally shaped uterus, and these seem more prone to producing menstrual problems, but these are in the minority. The most plausible explanation and the most recent one is wrapped up with the discovery of a new hormone called prostaglandin that is produced by the body. This is manufactured in women in the uterus, and it has a powerful effect in causing the muscle fibres of the uterine wall to contract rhythmically. It is also known that prostaglandin production is greatly stimulated by the female hormone progesterone, produced in increasing amounts during the second half of the menstrual cycle.

So it seems that with the build up of progesterone, prostaglandin is produced in maximum amounts just at the time when menstruation would be occurring. The violent cramp like pain and discomfort represents the uterine muscles actively contracting, and the other symptoms are a flow on from this. This is a very logical explanation, and further research will probably make the picture even clearer. On the other hand however, it may go down in history as just another theory as to its cause. There have been very many of them to date, and many doctors shrug their shoulders and wonder if any is true, including this most recent one.



Primary Dysmenorrhoea Treatment

The important aspect from the suffering woman’s point of view is what to do. She is not as concerned with the cause as with the remedy. Today, there are many different lines of attack. Here are some of them:

Pain-killers

Medication collectively referred to as analgesia will usually bring prompt, efficient relief from pain and discomfort. Many different lines are available, either on prescription from your physician, or over the counter from your pharmacist. Most contain the well known medications aspirin (acetyl salicylic acid), paracetamol and codeine in varying doses.



A simple remedy is paracetamol, 2 x 500 mg tablets three to four hourly. Alternatively, aspirin (soluble is often quicker in effect and may be dissolved in water), 2 x 300 mg tablets. Take this after food, as it may provoke nausea, being a gastric irritant. Some proprietary lines contain caffeine and codeine, which may assist; and some analgesics obtained by scripts from the doctor may have varying amounts of these ingredients. Most work quite successfully. Their use for half to one day is often adequate. Patients with the problem on a recurring basis should carry tablets with them when trouble is anticipated.

Antispasmodics

Doctors sometimes prescribe medications claimed to relieve spasm of the uterine muscle. These are usually a prescription-only line, and must be doctor-ordered and taken under correct medical supervision.



Anti-inflammatory Medication

For many years doctors have known that simple aspirin brings quick relief. It is also recognised that the anti-inflammatory drugs such as indomethacin, naproxen, ibuprofen and ketoprofen bring relief, even though these are generally used in arthritis! It seems that all three are powerful “prostaglandin antagonists”— in short, they destroy the prostaglandin in the uterus, and so stop its action and reduce the symptoms. These must also be given under proper medical supervision, for they are potent drugs, and must be treated with respect.

Hormone Therapy

The contraceptive pill has had a dramatic and major beneficial effect in reducing dysmenorrhoea. Once more, the hormones in the pill effectively prevent ovulation from taking place. In turn, this prevents progesterone from being formed, and stops prostaglandin from being manufactured. So, presto! There is no pain. Today, many young women in the dysmenorrhoea age bracket regularly take the pill for contraceptive reasons. Many notice that their period pains suddenly vanish.

In 1994 medroxyprogesterone (Depo Provera C150) was approved as an injectable contraceptive in Australia (much earlier in New Zealand). A single injection three-monthly prevents ovulation, which should inhibit periods and lessen dysmenorrhoea. Often, use of the pill or injection will solve the problem. Frequently, when the pill is discontinued, the period problem ceases also. But if not, medication may be continued. The pill is a potent combination of hormones, and in most Western countries it must be ordered by a doctor on a prescription and given under medical supervision. Its beneficial effect can be invaluable.

General care

There is little doubt that attention to general matters of physical activity, personal hygiene and commonsense living can also play a valuable part in ridding the system of dysmenorrhoea. Outdoor activity, participation in physical sports, commonsense attitudes to eating high-quality food, bowel regularity, adequate rest at night, can only help in a general sort of way. At least it equips the body to function more normally, and anything that will do this is north a trial—a long-term trial.