What a pain!
Menstrual pain is a common woe that's part of life for women of all ages, but what
do we really know enough about it? Here are six questions answered.
By Dr Kelly Loi, Obstetrician & Gynaecologist
What exactly causes period pain?
Painful periods are a common problem, and most women have some degree of usually mild pain. But in about 1 in 10 women, it can affect day-to-day activities, and in severe cases, women may be unable to go to school or work. Such pain is referred to as dysmenorrhoea.
Some women experience painful periods early in their teens, and this is often referred to as Primary dysmenorrhoea. There is usually no apparent underlying problem of the womb (uterus) or pelvis.
Where the womb is normal, it is not clear what causes Primary dysmenorrhoea. It is thought that during the process of removing the lining of the womb during the period, certain chemicals called prostaglandins cause the womb to contract. In women with period pain, there seems to be a build-up of too much prostaglandin, or the womb may be extra sensitive to the prostaglandins. This can cause the womb to contract too hard.
Are period pains a sign of something?
While period pains of Primary dysmenorrhoea are unlikely to indicate any problem in the womb, pain which become worse later in life may signal a problem. The period pains of Secondary dysmenorrhoea tend to occur in women in their 30s or 40s, and are more likely to reflect a problem of the womb or pelvis such as endometriosis and fibroids. Endometriosis is a condition in which the womb lining – the endometrium – is not shed properly but gets deposited around the back of the uterus, tubes and ovaries. Fibroids are muscle tumours of the uterus. Another cause of painful periods may be infection of the womb and fallopian tubes (pelvic inflammatory disease). Some types of intrauterine contraceptive device (IUCD, also known as the ‘coil’) also make painful periods worse.
How can women manage the pain?
Regular exercise and a healthy diet are good lifestyle habits to develop. They may help to improve the pain and should always be encouraged. Simple painkillers and muscle relaxants may also be helpful to some extent, although it is advisable to first ensure that there are no serious underlying gynaecological conditions.
When should one seek medical advice?
Seek medical advice if:
  • the pain is severe enough to interfere with your usual activities
  • the pattern changes. For instance, if the pain lasts longer than it used to, or starts several days before the period begins and lasts all the way through. This is uncommon with primary dysmenorrhoea which tends to cause pain only during the first one or two days of the period.
  • there are any unusual symptoms such as fever, vaginal discharge, sudden severe abdominal pain, pain during intercourse, or vaginal bleeding between periods or after intercourse.
What is the treatment of choice for specialists?
This would depend on the underlying problem. Investigations needed may include vaginal swab tests to assess for infection, blood tests, and an ultrasound scan of your uterus and pelvis. Options for treatment may then include appropriate medication such as antibiotics for infection, simple analgesia for pain relief, or hormonal medication.
In some situations, surgery may be advised, and this may include a hysteroscopy (an examination of the inside of your womb, using a telescope) or a laparoscopy (an examination of the internal organs of your pelvis, using a telescope).
With treatment of gynaecological conditions such as endometriosis or fibroids, the options also depend on the patient’s age and desire for fertility. For instance, conservative surgery to remove the endometriotic cysts or fibroids while keeping the ovaries and uterus intact may be more appropriate for women who are keen to maintain their childbearing abilities.
Can we look forward to the day when period pain will no longer accompany us through life?
With current medical and surgical advances, effective treatment is often possible. But while it may be available, it may not always be suitable, depending on the woman’s desire and need for fertility. There is, however, the day when period pains will stop: with menopause, when monthly periods end. On average, women become menopausal at around age 50.

Dr Kelly Loi