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Najma Nizar and Dr Gudly Nanda
20/3/2024
The process of menstruation is often considered impure in many societies around the world, including India. The un-scientific constructed myths and taboos created by the patriarchal society has plunged many women into despair and shame. Even as millennials, we have always hesitated to openly discuss menstruation and related subjects in public and this signifies how deep the patriarchy is entrenched into our minds. All these factors demand proper menstrual education for all, including men. It's vital to start early and appreciate that menstruation is a normal physiological phenomenon indicating a healthy and functioning female body. Habitually, we have experienced how society blocks us out when we raise our voices on women's issues. Repeatedly we have also dealt with the invalidation of not just our hard work and talent, but also our pain. So very often we have seen women being applauded for the sacrifices they make and the pain they gracefully bear.
But it’s time we recognize that all this applause means nothing but a general lack of interest in alleviating a woman's pain.
Today we will be focussing on Dysmenorrhea/Painful Menstruation which is often dismissed as normal menstrual cramps.
To begin with, Dysmenorrhea is not your "normal menstrual cramps". What distinguishes Dysmenorrhea from regular cramps is the severity of pain leading to incapacitation, affecting day-to-day activities and the requirement of medications.
Menstrual cramps occur when the uterus contracts to shed the inner endometrial lining. To describe in simple terms, Dysmenorrhea is due to hyper-contraction of the uterus, that squeezes the blood vessels, resulting in a lack of oxygen supply to its muscles. This in turn adds to the pain.
Dysmenorrhea has been classified into two categories: -
This kind of Dysmenorrhea has no identifiable pelvic pathologies. It affects nearly 50% of women after puberty. The pain in Primary Dysmenorrhea usually begins at the onset of menses and is commonly relieved within 12 hours of onset, not persisting for more than 2 days of menses. This is common in young girls and the intensity may reduce as they get older.
After ovulation, the remaining part of the follicle forms the Corpus Luteum which is responsible for the secretion of Progesterone (a hormone that is essential to maintain pregnancy). Whenever the egg goes unfertilized, the Corpus Luteum degenerates, leading to a sudden fall in Progesterone levels, which results in the onset of menses. During this there is also a release of Prostaglandins (PGF2α to be specific) that cause constriction of blood vessels, leading to a lack of oxygen supply to the uterine muscles. Increased production of these prostaglandins or increased sensitivity of uterine muscles results in Primary Dysmenorrhea.
Areas where you may experience pain:
Apart from these, individuals may show symptoms of
Those experiencing unbearable pain should definitely visit a doctor to rule out any other serious underlying conditions and to seek proper medical aid.
As the name suggests, this is usually secondary to other pelvic pathologies. Unlike Primary, pain in Secondary Dysmenorrhea starts 3 to 5 days before menses and lasts for a longer period of time interfering with one's quality of life.
Secondary Dysmenorrhea could be due to a range of issues such as:
By far, this is the most common cause of Secondary Dysmenorrhea. The endometrium is the inner-most lining of the uterus. At times, this lining may be found outside the uterus leading to a condition called Endometriosis. Ectopic endometrial tissue may be found at different sites including the ovaries (most common site of Endometriosis), the ligaments holding the uterus in place, the fallopian tubes, the intestines, and so on. Hence during each of your menstrual cycles, changes in this ectopic endometrial tissue lead to pain.
Besides Dysmenorrhea, Endometriosis is a common cause of infertility and dyspareunia (painful sexual intercourse). Depending upon the degree of symptoms and site of Endometriosis, your doctor might suggest hormonal pills or surgery in case of cysts.
This is when the inner endometrial lining of the uterus gradually grows into the muscles of the uterus (myometrium). Consequently, the uterus of affected individuals may be tender and larger in size. They may experience heavy bleeding (menorrhagia), and abnormal pain during menses. The condition may require surgery.
These are benign, solid tumours of the uterus. They vary greatly in size and are very common in women of reproductive age group and obese women. Though mostly asymptomatic, women may experience heavy menses (menorrhagia), infertility, dysmenorrhea, and constipation. Fibroids that are symptomatic and larger in size may require surgery.
Caused by bacteria (mostly Chlamydia and Gonorrhoea) that infect the reproductive organs. They are most often transmitted sexually. The uterus, fallopian tubes, or ovaries can get infected resulting in a very tender abdomen, pus discharge from the vagina, fever, and infertility. PID frequently needs hospital admission and treatment with antibiotics.
Congenital uterine malformations including septate and bicornuate uterus can lead to Secondary Dysmenorrhea. These malformations are necessarily managed by surgeries.
HANDLING DYSMENORRHEA:
It is always recommended to visit the doctor if you find your periods extremely painful. At the outset, your doctor may prescribe you anti-inflammatory medications or hormonal pills to alleviate pain 4. If required your doctor might perform a pelvic exam or an ultrasound as she/he seems fit to rule out any other pathology.
THE BRIDGE OF KNOWLEDGE:
The dismissive attitude towards women’s pain and their health overall needs to stop. Dysmenorrhea is not just a women’s issue but also a grave public health problem that leads to substantial loss of work hours and in turn a loss to the economy. While this shouldn’t be a factor to discriminate when appointing women to jobs, it must be kept in mind, to be empathetic about the issue, give them the space they need, the love they require, and, to focus the most, proper and diligent medical attention they deserve.
It is obligatory that individuals, whether menstruating or not, are equipped with the right facts to understand how dysmenorrhea actually differs from menstrual cramps. In India, where women are taught to suffer in silence; where school dropouts and absenteeism are increasing due to lack of in-depth information and a great deal of ignorance, where a school girl suffering from period pain, has absolutely no idea that it's manageable, it is imperative to build that bridge of knowledge so as to fill the gaps in healthcare for women, girls and the country as a whole.
Check out Pinkishe Foundation's social handle on Facebook & Instagram and keep yourselves updated on content related to Women Well-Being and Menstrual Education.
It's high time that women stood together, and brought along the men as an accomplice to a noble cause. Next time you have a friend, classmate, relative, or colleague who constantly complains of painful periods, remember it’s you who needs to support them, educate them and most importantly make sure they get the medical attention that has been long overdue.
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