Dysmenorrhea: Painful Periods Explained
By Dr Diksha S Chadha, MD
Like bleeding every month wasn’t enough, why on earth does it hurt so much! Sounds familiar? Majority of women and girls feel varying levels of discomfort and pain during the initial days of their periods. Bring this topic into discussion among any women group, and chances are that you will be bombarded with advise on how to deal with it. From hot water bottles to ajwain tea, from applying ointments on the belly to popping pills, the solutions outnumber the women discussing the problem itself. However, not many women are aware about the reason for the period pain. So lets take this opportunity to demystify period pains.
A woman’s menstrual cycle can be divided into two halves. The first half i.e. the first two weeks following the start of your periods is the phase where body works on producing hormones that lead to ovulation. The second half of the menstrual cycle i.e. the two weeks following ovulation, body produces progesterone to prepare for a possible conception by increasing the thickness of uterine lining. If conception occurs, the embryo is received by uterus and implanted in this thickened lining and pregnancy begins. In the absence of conception, the body receives feedback signal to stop the progesterone release. Once the progesterone decreases, the thickened uterine lining begins to shed. This shedding tissue needs to be pushed out and therefore the uterus contracts to make the shed tissue move out through the now open cervix.
The pain experienced during periods is on account of this contracting uterus and some additional factors. As the uterus contracts, it also squeezes the open blood vessels and nerves in its exposed inner lining. This adds to the level of experienced pain. Our body reacts to pain in any part of body by tensing up the muscles in that area. From evolutionary standpoint, this reaction is meant to protect the area under pain by thickening the muscles over it. So the menstrual cramps also lead to tensing up of lower abdomen muscles. These tense muscles increase the pressure in pelvic cavity and further add to the pain experienced by the woman. This cramping is typically the kind of menstrual pain experienced by most women. This also helps in explaining why having a full bladder or bloated up intestines adds to the pain of periods. As when these organs are full, they put additional pressure on already contracting uterus.
Most of the home remedies that you know of work on the principle of soothing the abdomen and its muscles so that there is no additional pressure on uterus. The hot water bottle acts as a counterirritant, meaning it confuses and alters the pain signals being sent to the brain (known as gating phenomenon). The herbal teas and such things ease up the bloated intestines and relieve pressure from uterus. The dark chocolate is rich in amino acid tryptophan, which is precursor of one of the happiness harmones serotonin. Overall the idea being to let the normally contracting uterus do its job without adding to its pressure and also to distress your self and relax in order to prevent tension in abdomen muscles.
The period pain relief strips available in the market also work on a combination of the above principles. These strips are designed in a way that once you apply them on the lower abdomen; the active ingredient in these strips gradually dissolves through the top layers of skin to dilate the blood vessels of the skin. This creates a sensation of warmth over the abdomen that confuses the pain signal from the uterus. Being placed over the abdomen muscles, they also help these muscles to relax and not tense up. As these are designed to work for up to 12 hours, they give you essentially the same results as a hot water bottle without the mess of refilling one every little while. Plus the strip has the advantage of not spoiling your clothes by water leakage or ointment application directly on the tummy. It’s discrete enough for use in the office. In fact it’s the perfect example of how science and traditional home remedies work together to create useful technology.
A lot of women often ask the question if this strip will help relieve extreme pain experienced by them. This is the kind of pain that disturbs your daily routine and makes you call in sick. Medically, if you experience such pain, it might be due to endometriosis. Let’s take a second to understand this. In some women, the same tissue that lines the uterus is also present in other areas inside the abdomen, something that is known as endometriosis. As this tissue is same as that of uterine lining, it gives the same response to the changing harmone levels in the body. It thickens under progesterone and sheds in its absence. But since this tissue is present outside the uterus, it has nowhere to escape the body and it causes intense inflammation and pain inside the abdomen cavity, leading to the extreme pain of dysmenorrhea experienced by some women. This pain can be intense enough to cause vomiting and is on the extreme other end of menstrual pain spectrum. Such extreme pain will not respond much to any of the home remedies including the strip. It requires gynaecological consultation and prescription medication depending on location of endometriosis and severity of pain experienced. Medical consultation will also rule out other causes of dysmenorrhea including fibroids, PID etc.
Some of these women with endometriosis will naturally find relief in symptoms after their first childbirth. Usually the high level of progesterone in pregnancy destroys the endometriosis tissue. That is why you may find many women joking that after experiencing labour, they no longer feel the period pain! While experiencing labour might have enhanced pain tolerance in these women, ultimately the destruction of endometriosis tissue due to progesterone of pregnancy might be the more logical scientific explanation to reduced period pain in women who have given birth.
In conclusion, all women do not need to wait to get pregnant to get rid of the menstrual cramps. All women may not find relief even after the pregnancy. But one thing that can be achieved with logical understanding of why menstruation hurts, is that the fear of period pains can be reduced. In majority women, home remedies and the right mindset can help conquer the cramps and normalize that dreaded first day!