Dear Gloria,
Menstrual pain is quite common and often inevitable. This is due to the mechanism by which the uterus contracts to expel its lining, involving hormone-like substances known as prostaglandins. These compounds are crucial for triggering uterine contractions. Without them, the unfertilised egg and uterine lining cannot be expelled.
Prostaglandins are involved in both inflammation and pain. They also play important roles in producing protective mucus in the stomach lining, preventing ulcers, and aiding blood clotting.
Higher levels of prostaglandins are associated with more severe menstrual cramps.
Doctors often prescribe selective prostaglandin inhibitors, which block the prostaglandins responsible for inflammation and pain, without interfering with their other essential functions like stomach protection and blood clotting. However, common over-the-counter drugs such as ibuprofen block all prostaglandins. This can disrupt gastric protection and increase bleeding during menstruation. Consequently, some women have developed stomach ulcers or experienced excessive menstrual bleeding after using these medications.
Dysmenorrhoea
When menstrual pain becomes severe or prolonged, it is referred to medically as dysmenorrhoea. It affects between 45 and 95 per cent of women of reproductive age and may or may not be linked to an underlying reproductive health issue.
Possible underlying causes
- Endometriosis or adenomyosis – when the tissue that lines the uterus grows outside the uterine cavity
- Pelvic inflammatory disease (PID) – an infection of one or more upper reproductive organs such as the uterus, fallopian tubes, or ovaries
- Fibroids – non-cancerous growths in or around the uterus
Treatment, outlook
There is evidence suggesting that dysmenorrhoea may improve after childbirth and tends to lessen with age. Proper medical investigation and treatment of any underlying causes often lead to significant relief.
