Dr Phil Green: Menstrual Pain & You

Experiencing painful periods is a significant issue, impacting women's performance at school and work. In extreme cases, about 10% of women may need bed rest due to severe symptoms. Painful periods, known as dysmenorrhoea, can be categorized into two types:

Primary Dysmenorrhoea:

• Begins about a year after the onset of periods, most common between ages 15 and 25.
• Symptoms include cramping pain in the lower abdomen, potentially moving to thighs and lower back.
• Usually noticed about a day before the period starts, with symptoms typically decreasing with age.
• Treatment includes anti-inflammatory medication, combined oral contraceptives, paracetamol, alverine citrate, and other non-drug options like TENS devices.

Secondary Dysmenorrhoea:

• Uncommon before the age of 25.
• May involve heavy bleeding, painful intercourse, or infertility.
• Causes include endometriosis, pelvic inflammatory disease, fibroids, womb polyps, pelvic congestion syndrome, intra-uterine contraceptive device, and ovarian cysts.

Endometriosis:

• Affects about 10% of reproductive-age women.
• Symptoms can be non-specific, often mimicking other conditions.
• Causes pelvic pain, menstrual cramps, fatigue, and depression.
• Associated with infertility, heart disease, arthritis, and more.
• Diagnosis involves considering symptoms, a pelvic examination, and an ultrasound scan.
• Medical management includes pain relief, hormonal therapies, and sometimes surgery for severe cases.
• Endometriosis may impact fertility and tends to resolve during menopause.

Adenomyosis:

• Presence of womb lining tissue in the muscle layer of the womb.
• Commonly diagnosed in women aged 40 to 50.
• Symptoms include painful, heavy, or abnormal periods and an enlarged womb.
• Treatments involve hormonal contraceptives, high-dose progesterone-based medications, and the intra-uterine system (e.g., Mirena coil).