Menstruation is a normally monthly occurrence for women. It entails the shedding of the womb lining and passing it out through the birth canal and vagina. During this process, it is normal to experience slight pain or discomfort. However, it is abnormal to experience excessive pain, the kind of menstrual cramps that render one unable to attend to her normal daily activities.

Menstrual cramps are medically referred to as dysmenorrhea. Dysmenorrhea is divided into two: primary and secondary dysmenorrhea. There are several causes of menstrual cramps these include:




Risk factors

For starters, some women have a higher probability of experiencing painful menstrual periods. This could be as a result of various risk factors which include:

  • Family history of painful menstrual periods
  • Smoking
  • Irregularly occurring periods
  • Early puberty this starts before the age of 11
  • Periods that comes with heavy bleeding
  • Never having given birth
  • Being below 20 years of age




Causes of pain

A. Primary dysmenorrhea

B. Secondary dysmenorrhea

Primary dysmenorrhea usually occurs when a healthy woman experiences pain before or during menstruation. Secondary dysmenorrhea




1. Prostaglandins

Primary dysmenorrhea is menstrual pain that occurs around the time that menstrual periods first begin in otherwise healthy young women. In most cases, this pain not related to a specific problem with the uterus or other pelvic organs. Increased activity of the hormone prostaglandin, which is produced in the uterus, is thought to play a role in this condition. Prostaglandins are hormone-like secretions which trigger muscular contractions to aid your uterus in getting rid of its lining. It is possible for these contractions to cause inflammation and pain. There is a link between higher levels of prostaglandins and menstrual pain.

For secondary dysmenorrhea, it is menstrual pain that develops later in women who have had normal periods. It is a case where a woman would experience pain during menstruation that she didn’t experience previously. It is often related to problems in the uterus or other pelvic organs, such as. The pain in case of secondary dysmenorrhea can be as a result of the following:




2. Endometriosis

via: slideshare.net
via: slideshare.net

Endometriosis occurs when cells from the lining of your womb (uterus) grow in other areas of your body. This can cause pain, heavy bleeding, bleeding between periods, and problems getting pregnant or infertility.

Endometriosis occurs when these cells grow outside the uterus in other parts of your body. This tissue may attach on your ovaries, bowel, rectum, bladder and lining of your pelvic area.  Whenever these cells are shed, there is pain.

3. Fibroids

via: fibroidclinic1
via: fibroidclinic1

They are also known as uterine fibroids, myomas, or fibromyomas. Fibroids   are tumors that grow in a woman’s womb (uterus). These growths are typically not cancerous (benign). This non-cancerous growth in the uterus can cause heavy and painful periods. Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds. Although it is possible for just 1 fibroid to develop, most often there is more than 1.

No one knows exactly what causes fibroids. They are thought to be caused by hormones in the body or genes that may run in families. The reason behind the pain is that the uterus must contract (cramp) to expel the large blood clots that often result from heavy bleeding. Fortunately, fibroids do not put women at increased risk of uterine cancer and very rarely become cancerous.




4. Pelvic inflammation

via: mayoclinic.org
via: mayoclinic.org

Pelvic inflammatory disease (PID) is an infection caused by bacteria. It is the condition when bacteria from the vagina or cervix travel to reproductive system (womb, ovaries and fallopian tubes) become infected which makes them irritated and swollen. Most of the time, PID is caused by bacteria from chlamydia and gonorrhea. This could be as a result of untreated sexually transmitted infections. Having unprotected sex with someone who has an STI can also cause PID. Left untreated, PID can cause inflammation, scarring, painful menstruation, and infertility. Bacteria can also enter your body during a medical procedure such as: childbirth, endometrial biopsy, getting an intrauterine device (IUD), Miscarriage, Abortion.

5. Premenstrual syndrome

Premenstrual syndrome (PMS) is a condition that affects a woman’s emotions, physical health, and behavior during certain days of the menstrual cycle, generally just before her menses. PMS symptoms start five to 11 days before menstruation and typically go away once menstruation begins. The cause of PMS is unknown.

The exact cause of PMS is not known. many researchers believe that a change in hormone levels at the beginning of the menstrual cycle may be to blame. Levels of estrogen and progesterone increase during certain times of the month. An increase in these hormones can cause mood swings, anxiety, and irritability. PMS may be related to social, cultural, biological, and psychological factors. Up to 3 out of every 4 women experience PMS symptoms during their childbearing years.

6. Adenomyosis

via: mygynae.co.uk
via: mygynae.co.uk

Adenomyosis is the migration of endometrial cells into the muscle wall of the uterus. It causes pain during periods because the tissue that lines the womb grows on the wombs muscular wall. Adenomyosis is similar to endometriosis, except instead of the endometrium implanting itself outside of the uterus, it is found embedded deep within the uterine muscle. Adenomyosis is usually seen in women over age 30 who have already given birth but it has been seen in teenagers as well. The uterus of women with adenomyosis acts like a bruised muscle. Adenomyosis cause painful central cramping and painful intercourse, which can hurt up until a day or two after.




7. Intrauterine device 

via: babymed
via: babymed

Use of birth control measures like intrauterine devices (IUD) made of copper can increase the levels of paid during a period. A copper IUD is a non-permanent, non-hormonal form of birth control that can prevent pregnancy for up to 10 years. The device, which is placed in the uterus by a licensed healthcare provider, works by continuously releasing copper, which immobilizes sperm and prevents egg implantation. A copper IUD, as opposed to a progestin IUD, can make menses heavier and more painful, particularly in the first few cycles after insertion.  But if you have had your copper IUD for years and suddenly develop pain, look for another reason. Your IUD is unlikely to be the culprit.

8. Cervical stenosis

Cervical stenosis means that the opening in the cervix (the endocervical canal) is narrower than is typical. In some cases, the endocervical canal may be completely closed. A stenosis is any passage in the body that is narrower than it should typically be. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus. It is a rare condition where the cervix is very constricted so that it slows down menstrual flow.

Cervical stenosis may be present from birth or may be caused by other factors like surgical procedures performed on the cervix, Trauma to the cervix, Repeated vaginal infections , Atrophy of the cervix after menopause, Cervical cancer, Radiation.




9. Uterine Defects

While a female fetus is still in its mother’s uterus, its own uterus develops from two structures known as mullerian ducts. In some cases the uterus does not form correctly, which can cause infertility, painful periods, and painful intercourse.  s

For women with structural anomalies such as a bicornuate uterus (two uteri that lead to one cervix), septate uterus (normal uterus with a fibrous band of tissue bisecting it), unicornuate uterus (a uterus that develops from only one mullerian duct), uterus didelphys (two uteri, two cervices, and a septum, or membrane, dividing the vaginal canal) menstrual pain stems from blockages and membranes dividing the uterus and vagina.

10. Ovarian cyst

via: mayoclinic.org
via: mayoclinic.org

An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. If the cyst either breaks open or causes twisting of the ovary severe pain may occur. This may result in vomiting or feeling faint. The majority of cysts are harmless.

Often cysts are simply observed over time. If they cause pain, medications such as paracetamol (acetaminophen) or ibuprofen may be used. Pelvic inflammatory disease may also result in cysts. Rarely cysts may be a form of ovarian cancer.

Hormonal birth control may be used to prevent further cysts in those who are frequently affected. However, evidence does not support birth control as a treatment of current cysts. Ovarian cysts are present in about 16% of women after menopause and if present are more likely to be cancer.




It is normal to experience slight pain during your monthly period. However it may be advisable to visit your gynecologist if your cramps get in the way of your daily activities. Seek medical intervention if:

  • You are passing blood clots
  • Pain after IUD has been placed in your reproductive system
  • Pain in the pelvis even when you are not menstruating
  • Diarrhea and nausea during monthly periods
  • Painful menstruation that last for more than three months

Treatment

Some of menstrual cramps can be treated at home using simple procedures. However, severe cases should be treated medically with the help of a medical practitioner. Some causes of menstrual cramps like fibroids, cysts or endometriosis may require surgery. Antidepressants, non-steroidal ant-inflammatory drugs and pain relievers are used to treat menstrual cramps. Taking warm baths, yoga, abdominal massage, regular exercise and eating the right food can help you treat menstruation at home.




References:

www.nlm.nih.gov

www.everydayhealth.com

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