The Treatment of Dysmenorrhoea

Article by Dr Milton Lum, FRCOG, adopted from the book, Period Problems

An individual does not need to suffer from dysmenorrhoea as there are effective means of treatment. However, if the pain is mild and not   troublesome, she may not need treatment.

                Antiprostaglandins such as ibuprofen and naproxen are medicines that prevent the formation of prostaglandins that cause menstrual pains. In about 70% of cases, the medication also usually prevents some of the other menstrual symptoms caused by prostaglandins like nausea, diarrhoea and general aches. However, some of the antiprostaglandins may upset the stomach and are best taken with at least some food.

            The medications are started on the first day of the period or when the pain starts, and are needed for a day or two. If after two or three cycles there is no improvement in the pain relief, consult your doctor who may increase the dose or change the medication.

            Oral contraceptives (the Pill), by itself, relieve or reduce the pain in 80-90% of women with primary dysmenorrhoea. The Pill prevents ovulation and alters the normal hormone changes of the menstrual cycle. The resulting decrease in the production of prostaglandins leads to little or no menstrual pain.

            The drawback is that the pills have to be taken daily for a menstrual pain that lasts only a few days. This is not an inconvenience for those using the Pill for contraception, as it provides pain relief as an additional benefit. With your doctor’s advice, you can decide whether this is the right choice for you.

            Although the Pill might have some side effects like breast tenderness or nausea, these symptoms are uncommon with the low-dose pills available today. Women who smoke have an increased risk of blood clotting and are advised not to use the Pill.

            The Levonorgestrel releasing intrauterine system has been shown in some observational studies to be effective in reducing pain in women with secondary dysmenorrhoea, especially when associated with endometriosis.

            The treatment of secondary dysmenorrhoea depends on its specific cause. The treatment may be with medications or surgery or both. An individual with endometriosis is treated differently from someone else who has fibroids or cramps due to an IUCD (intrauterine contraceptive device). The treatment may bring about pain relief but the results are different for each individual.

            Many women experience period pains. Severe dysmenorrhoea, in all but rare instances, can and should be treated. If menstrual pains trouble you, discuss with your doctor the treatments available. It is most likely that you will be able to stay active every day of the month free of the disruption and distress of painful periods •