Dr Phil Green: Menstrual Pain & You

Menstrual pain is a significant issue that can affect women's ability to perform well at school and work. In severe cases, around 10% of women may experience symptoms so intense that they require bed rest. This condition, known as dysmenorrhoea, can be classified into two main types:

Primary Dysmenorrhoea:

• Typically begins about a year after menstruation starts, commonly affecting individuals aged 15 to 25.
• Symptoms include cramping pain in the lower abdomen, which may radiate to the thighs and lower back.
• Pain usually starts a day before menstruation and often lessens with age.
• Treatments include anti-inflammatory medications, combined oral contraceptives, paracetamol, alverine citrate, and non-drug methods such as TENS units.

Secondary Dysmenorrhoea:

• Rarely occurs before age 25.
• May be accompanied by heavy bleeding, painful intercourse, or infertility.
• Often caused by conditions such as endometriosis, pelvic inflammatory disease, fibroids, womb polyps, pelvic congestion syndrome, intrauterine contraceptive devices, and ovarian cysts.

Endometriosis:

• Affects about 10% of women of reproductive age.
• Symptoms can be vague and often mimic other health issues.
• Causes pelvic pain, menstrual cramps, fatigue, and depression.
• Linked to complications such as infertility, heart disease, and arthritis.
• Diagnosis involves evaluating symptoms, a pelvic exam, and possibly an ultrasound.
• Treatment options include pain relief, hormonal therapies, and, in severe cases, surgery.
• Endometriosis may impact fertility and typically improves during menopause.

Adenomyosis:

• Involves endometrial tissue growing into the muscular wall of the uterus.
• Commonly diagnosed in women aged 40 to 50.
• Symptoms include painful, heavy, or irregular periods and an enlarged uterus.
• Treatment options include hormonal contraceptives, high-dose progesterone medications, and intrauterine systems (e.g., Mirena coil).

In summary, menstrual pain is a prevalent issue with a range of causes and treatment options. Persistent symptoms should be evaluated by a healthcare professional, and additional support can be sought from organizations such as Endometriosis UK, NICE, and RCOG.