Painful Periods or Dysmenorrhoea the facts
Painful periods or dysmenorrhoea is known as primary dysmenorrhoea when no underlying cause is know. However if secondary cause such as certain reproductive disorders, such as endometriosis or fibroids, is known as secondary dysmenorrhoea (1). In primary dysmenorrhoea, it is thought that the muscles of the uterus squeeze and contract harder than normal to shed the thickened lining (endometrium). These contractions may also reduce blood flow to the uterus, making the pain worse, sometimes cramps ease after passing large pieces of the endometrium.
Symptoms of primary dysmenorrhoea
- Pain low in the abdomen that can spread to the lower back and legs
- Pain that is gripping or experienced as a constant ache
Also commonly seen
- Onset of pain in the 24 hours and ending after first few days of bleeding
- Passing of clots in menstrual blood
- Nausea and if severe vomiting
- Changes in bowels such as constipation leading up to the period then loose bowels with the onset of bleeding (1)
Causes of primary dysmenorrhoea
In primary dysmenorrhoea; menstrual cramps without diagnosed underlying cause. However there needs to be investigation to rule out endometriosis such as laparoscopy, the pelvic ultrasound to rule out fibroids and cysts. From a western sense increased prostaglandins – the hormones that enable your uterus to relax and contract become excessive and cause involuntary contractions. These contractions can occur so violently that it actually cuts of blood supply to the blood vessels, it’s the no oxygen to the smooth muscles in the uterus caused by the contractions that create the pain signals. The reason for the increased prostaglandins is not known.
Some of the prostaglandins can escape the uterus and affect other smooth muscles in the area, such as the bowel. This is why many women also experience changes in stools such as constipation and diarrhea at period time. Aspirin is a very mild prostaglandin inhibitor so women who have low levels may respond to this treatment, however many find that this only ‘takes the edge off’ the level of pain they are experiencing (1).
Traditional treatment for primary dysmenorrhea
Treatment options often listed are;
- Bed rest during the first day or so of the period
- Applying heat, such as a hot water bottle, to the abdomen
- Pain-relieving medication, such as paracetamol
- Medication that inhibits prostaglandins, such as ibuprofen or other anti-inflammatory medication
- The oral combined contraceptive pill, which usually reduces period pain (1)
It is important to note that many of the above treatment options offer temporary relief, so many women are faced with painful periods each and every month of the prospect of using the oral contraceptive pill to avoid having periods.
Acupuncture treatment of dysmenorrhoea Ferntree Gully
From a Traditional Chinese medicine perspective Painful periods, Adenomyosis and Endometriosis results from a slowdown and stagnation of blood flow to the pelvis, typically caused in Chinese medicine terms by cold. The stagnation can gradually becomes visible on laparoscopy as endometrial lesions. We can see the slowdown and stagnation of blood flow in the menstrual period; Blood that can be in appearance dark clotty, un-fresh.
From a more modern and integrative approach we understand that perspective painful periods, which are termed membranous dysmenorrhea is caused by the dysfunction of the corpus luteum, causing a deficiency in the hormone progesterone and a relative excess in the hormone oestrogen as well as high prostaglandin levels.
When progesterone is insufficient the endometrium is poor, and cannot breakdown and dissolve as it normally would during a period. The lack of breakdown makes it difficult to peel of the uterine wall, thus increasing the contractions of the uterine muscles. As we age or after childbirth the uterine walls often become less toned so the pain decreases but the heaviness and clotting is still present.