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It’s not uncommon for girls and women to have cramps during their menses. It was reported that as many as 86% of women in Malaysia said they have ever had period pain, and a significant portion of this group of women claimed that the menstrual cramps has affected their ability to work.
Indeed, although menstrual cramps appear to be common among the women, it should not be taken lightly as it can affect the quality of life or even signal an underlying health issue.
Note: The term "woman" will refer to patients who experience dysmenorrhea. However, we recognize that not all people who experience dysmenorrhea identify as women, and we encourage the reader to consider the specific counseling needs of transgender men.
Menstrual cramp, or clinically known as dysmenorrhea, is painful menstruation. Dysmenorrhea can be a primary process (which is the majority of the cases) or caused by an underlying, sinister pathology.
Patient with dysmenorrhea usually describes the following:
Timing – The pain typically starts one to two days before or with the onset of menses and then gradually diminishes over 12 to 72 hours. It usually happens in every menstrual cycle. The pain is usually crampy and intermittently intense but may be a continuous dull ache.
Location – It is usually confined to the lower abdomen area, nearby the hips. Some women may also have severe back and/or thigh pain. The location of pain is important as pain involving other areas may signal other diseases and not dysmenorrhea.
Severity – The severity of the pain ranges from mild to severe. In fact, a comprehensive review of a large group of women in their reproductive age has found that 2 - 29% of the women studied experienced severe menstrual cramp.
Other discomforts - Besides the cramps, many women also experience nausea, diarrhea, fatigue, headache, and a general sense of weakness.
As mentioned above, dysmenorrhea is classified into primary dysmenorrhea and secondary dysmenorrhea.
Primary dysmenorrhea refers to the presence of recurrent, crampy, lower abdominal pain that occurs during menses without any obvious disease that could explain the pain. Primary dysmenorrhea is usually diagnosed among the adolescents and young women. It tends to improve after childbirth and resolves with advancing age.
Secondary dysmenorrhea has the same pain symptoms but occurs in women with an underlying health problem that explains the pain, such as endometriosis, adenomyosis, or uterine fibroids. This group of women usually have other symptoms that distinguish them from primary dysmenorrhea. Secondary dysmenorrhea is also more common among women with older age. The doctor will be the one who examines these differences and makes the diagnosis.
As the treatment for secondary dysmenorrhea requires treatment of the underlying disease, hence only the treatment for primary dysmenorrhea will be discussed.
There are various types of treatment available for primary dysmenorrhea and the decision on which treatment is adopted will be guided by severity of pain and limitation of daily activities.
Paracetamol + pamabrom - This formulation is the most common over-the-counter (OTC) product for mild menstrual pain. No prescription is required for this product. Paracetamol relieves the cramp while pamabrom reduces bloating and water retention as a result of menstruation. Kindly consult the pharmacist on the correct use of medication.
Non-steroidal anti-inflammatory drugs (NSAIDs) - NSAIDs is a group of various drugs which is commonly used as painkillers. They are more effective than paracetamol at relieving pain. Many studies have reported that patients experienced significant pain relief after taking NSAIDs. For instance, a study found that an initial dose of 550mg naproxen sodium (an example of NSAIDs), followed by the 275mg one is effective at relieving the pain. With that being said, women who take NSAIDs need to be aware of its side effects, such as gastric irritation. There is insufficient evidence to determine which (if any) individual NSAID is the safest and most effective for the treatment of dysmenorrhoea.
Hormonal oral contraceptives (OCs) -- Not only OCs are used to prevent pregnancy, but it is also used to treat dysmenorrhea. It is usually a therapy for patients who are not sexually active but NSAIDs failed to relieve their pain or cannot tolerate the side effects of NSAIDs. In the case where women who experienced primary dysmenorrhea and at the same time desire contraception, then hormonal OCs can be the first go-to. OCs prevent menstrual pain by suppressing ovulation, thereby decreasing uterine prostaglandin levels, reducing contraction and cramps. After several months of use, women may also experience reduction of menstrual flow, which indirectly reduces menstrual cramps as well.
If you experience painful menstruation that disrupts your daily activities, kindly seek medical advice and let the healthcare professional help.
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