Many women reading this piece will have experienced the pain that arrives like clockwork each month with the arrival of their period. Estimates vary, but could be as high as 95 per cent of women, and as many as half of those could have suffered badly enough to seek medical help. It is prompted by a completely normal occurrence, once a month, every month throughout a woman’s fertile life. Period pain – or dysmenorrhoea, derived from the Greek words dys, meaning difficult, painful, abnormal; meno, month; and rrhea, to flow. Dysmenorrhoea can occur a few days before menstruation as well as during a period, but usually subsides as it ends. Dr Noella Lo, a gynaecologist at Hong Kong’s Femina Health Centre, says period pain is divided into two groups. “Primary dysmenorrhoea occurs in the absence of any underlying uterine condition,” she says, “whereas secondary dysmenorrhoea occurs where pelvic pathology (pelvic inflammatory disease) is present.” Just before a woman’s period begins, the endometrial cells – the cells that form the lining of the uterus – begin to produce large amounts of prostaglandins, hormones that constrict the blood vessels in the uterus and make its muscle layer contract, causing the painful cramps women know so well, cramps that make us reach for pain relief tablets and hot-water bottles. The rural Indian whose invention ended women’s period shame Prostaglandin levels are at their highest just before and during the first couple of days of menstruation, and there may be pain in the abdomen, lower back and the tops of the thighs. There may also be bad headaches. Secondary dysmenorrhoea, though, as Dr Lo observes, is more complicated. “There are a number of clinical conditions with underlying pelvic pathology which can lead to secondary dysmenorrhoea. The most common cause of secondary dysmenorrhoea is endometriosis”– when the tissue that normally lines the uterus, the endometrium, begins to grow outside the uterus. Adenomyosis, when the endometrium grows into the muscle wall of the uterus, the myometrium, is another cause, as is chronic pelvic inflammatory disease. “How these conditions cause pain is still uncertain,” says Lo, though most of them result in abnormal uterine contractions. Much less common causes of secondary dysmenorrhoea, she continues, include Allen Masters syndrome (scarring secondary to laceration of the broad ligaments, usually during childbirth) and congenital uterine abnormalities, among others. Theories as to why they cause pain also relate to the production of abnormal uterine contractions. But in the general population, and where secondary dysmenorrhoea is not indicated, why do some women seem to suffer period pain so much more than others? Risk factors include early menarche (the onset of periods), nulliparity – when a woman has never delivered a baby or sustained a pregnancy beyond 20 weeks – and family history. “Women with a longer duration of menstruation and heavier menstrual flow,” says Dr Lo, “are significantly more likely to have dysmenorrhoea, but there is no association with cycle length. Most studies indicate that cigarette smoking is correlated with dysmenorrhoea.” Pakistani team develops menstrual game app to break taboos So, what can be done about it – apart from clutching that hot-water bottle to your tummy and willing your period to end? Period pain is no joke, and can affect quality of life. A study from the University of Bath indicates gnawing period pain can be such that it causes ‘attentional interference’ – a woman’s inability to focus as the pain interferes with their daily actions. A Canadian study showed that of the 1,546 women interviewed with primary dysmenorrhoea, 60 per cent described their pain as moderate or severe, half of those reported that their activities had been limited as a result, and 17 per cent reported missing school or work as a result. In some women, the pain is so severe – according to research done by Professor John Guillebaud at University of College London’s Institute for Women’s Health – it can be as painful as having a heart attack. Exercise can help relieve cramps, as it prompts the release of beta-endorphins, natural opioids – our own “human morphine,” according to Dr Gustavo Rossi, MD, an obstetrician-gynecologist at Virginia Hospital Centre in Arlington. “It produces analgesia (pain relief) and helps to burn the prostaglandins – chemicals released during menstruation that cause muscle contractions – much faster.” Nepali teen dies from snakebite after being banished for having period Exercise can also be useful to cope with, even alleviate, period pain as it improves circulation, boosts mood (those endorphins again) and relieves stress which can exacerbate menstrual cramps. The best exercise for relieving menstrual pain, experts agree, is aerobic – something that gets your heart rate up, such as brisk walking, cycling or swimming. Yoga positions and stretches can also be beneficial as they help strengthen abdominal muscles and stimulate pelvic blood flow. Try the cat, cow and cobra poses. Treatments for primary dysmenorrhoea, Dr Lo says, include painkillers such as ibuprofen; the combined oral contraceptive pill and use of a hormone-releasing intrauterine system (IUD); acupuncture; Chinese herbal medicine; behavioural therapy including relaxation training and dietary therapy that includes taking Vitamin B1 and magnesium. In secondary dysmenorrhoea, any treatment strategy should be based on treatment of the underlying disease. The bottom line is that there is usually something to be done to manage menstrual cramps. Talk to your doctor. Don’t just assume you have to put up with it, especially if it compromises your quality of life for a few days every month.