Dysmenorrhoea

What are the symptoms of this condition?

It is estimated that between 40% and 70% of women of childbearing age are affected by dysmenorrhoea at some point in their lives, which is characterised by cramping pains and discomfort around the time of the monthly period. Whilst discomfort may occur in many women, for some the pain disrupts their routine to the extent that they may require time off work or school; the pain may last for two to three days after the onset of the period.

The pain will usually be felt in the lower abdominal region, and may radiate round to the back or into the thighs.

Sometimes the pain is associated with other symptoms, such as a headache, and it may be so severe that it causes fainting or sickness.

What is the cause of the condition?

Dysmenorrhoea is classified into two types: primary, where there is no other serious illness or underlying disease; and secondary, where the pain is caused as a result of another condition or disorder.

Primary dysmenorrhoea

usually starts a few months after the first period a woman experiences and results from contractions or spasms in the womb (uterus). This is a very muscular organ - muscles cover the whole of the main body of the womb including its 'neck' (the cervix), where it joins the vagina. Muscle spasms and contractions in the neck of the womb may be the main contributors to the pain and discomfort experienced, and this in turn may be caused by a reduction in the blood flow to these muscles, brought about by a chemical messenger called prostaglandin F2. Prostaglandins come in a variety of types, and generally seem to play a part in pain control (by making nerve endings more sensitive and heightening the sensation of pain) and in triggering inflammation.

One of the effects of this chemical is to stimulate muscle contractions in the walls of the uterus; it may also be responsible for reducing the blood supply to those muscles - both of these actions can cause pain.

Secondary dysmenorrhoea

often starts later in life (it is most commonly seen in those aged over 30) and may be triggered by an underlying illness or disease. Common causes include endometriosis, and inflammations or infections in the uterus or pelvic area. The fallopian tubes, which lead from the ovaries to the uterus, can become infected or inflamed and this will cause pain. Endometriosis is a condition where the tissue which normally lines the uterus (the endometrium) is found in other areas - including the outside of the uterus, and elsewhere in the pelvis - and because this tissue undergoes the monthly cycle of thickening, shedding, and bleeding, this can cause considerable pain in the affected area, which may start anything up to a week before menstruation.

Another trigger may be the fitting of an intra-uterine contraceptive device (IUD or 'coil'), or childbirth. Either of these may trigger dysmenorrhoea or change the severity of the pain in existing sufferers.

What complications might occur?

Usually there are no complications with dysmenorrhoea, unless an underlying gynaecological disease causes it; the potential complications would depend on the condition, for which your doctor will give you more advice.

What can I do to treat myself?

The most effective treatment will vary from one woman to another. Resting in bed may help, as may placing hot water bottles on the lower abdomen; drawing the legs up to the chest can also help ease the cramping sensation. A number of medications are available from Pharmacy2U to assist with managing the pain and discomfort - these are detailed in the next section.

What treatments are available for me to purchase?

Treatments and remedies available without a prescription are of three kinds: painkillers; anti-spasmodic drugs, which reduce the power of muscle contractions; and food supplements.

Painkillers
Simple painkillers will help to reduce the pain of dysmenorrhoea. Aspirin and ibuprofen are most effective, as they also help to block the effects of the prostaglandins which may be causing the pain. Ibuprofen is usually the most effective in relieving dysmenorrhoea, however it may cause stomach irritation in some people, and should not be taken by asthmatics; if this is the case, paracetamol would be a better choice of painkiller.

Click here to view the full range of Pharmacy2U painkillers

Anti-spasmodics
Products containing hyoscine will help to reduce the pain by reducing the muscular contractions of the uterus. Hyoscine is an ingredient in the product Buscopan and, along with painkilling ingredients, Feminax Tablets.

Click here to view products containing antispasmodics.

Food Supplements
Other supplements are believed by many women to relieve the symptoms of the pre-menstrual syndrome (PMS). These include Evening Primrose Oil and Vitamin B6 tablets, which should not be taken above the recommended dose, but can be taken safely alongside the other products listed above.

To view the Pharmacy2U range of Evening Primrose Oil products please Click here.

If you are at all uncertain about which product to purchase please consult the Pharmacy2U pharmacist.

What treatments are available from my doctor?

Aspirin and Ibuprofen are known as 'Non-Steroidal Anti-Inflammatory Drugs', or NSAIDS. Your doctor can provide alternative, stronger, NSAIDs on prescription, and in some cases may also recommend the oral contraceptive pill, as this can be very effective at reducing or eliminating the symptoms of dysmenorrhoea.

What additional investigations might be needed?

Pain accompanying the monthly periods can sometimes indicate disease in the pelvis or reproductive organs. There may be changes in the lining of the uterus, inflammation of the fallopian tubes or abnormal adhesions between different parts of the reproductive organs. Determining the true cause may involve examining the uterus and cervix using a flexible fibre-optic device, called a laparoscope; this procedure would be carried out in hospital - your doctor will refer you if necessary.

Any other information I should have?

Primary dysmenorrhoea is most common in women aged between 17-25, and becomes uncommon after childbirth. Secondary dysmenorrhoea, which is itself a symptom of another underlying condition, usually occurs in later life, from the age of 25 onwards. If you suspect that you are suffering from secondary dysmenorrhoea, or the painkillers that are available without a prescription are not adequate to control your symptoms, you should talk to your doctor. For further advice, ask the Pharmacy2U pharmacist or see your family doctor.