Monique Rainford

Ever so often, a teenager may come into my office, either alone or with her mother, complaining of very painful menstrual periods.

The term used to describe this condition is dysmenorrhoea. It is one of the most common reasons for a teenage girl to miss school and it is also very common in women of childbearing age. Up to 90 per cent of teenage girls may have dysmenorrhoea but it is severe in only about 15 per cent of them.

There are two basic types of dysmenorrhoea:

1) Primary dysmenorrhoea (the focus of this article) occurs when a woman has normal female organs.

2) Secondary dysmenorrhoea happens when the girl or woman has an abnormality of her female organs.

Crampy in nature

Primary dysmenorrhoea usually starts between one and three years after a young woman starts her normal monthly periods. The pain occurs in the lower, mid-abdominal (pelvic) region and is crampy in nature. It usually begins within a few hours of the start of the period and lasts one to two days.

However, in some young women, the pain may start one to two days before her period and may continue up to seven days after the flow has begun.

She may feel the pain travelling in her back and along her inner thigh. She may also have nausea, vomiting, diarrhoea, headache and feel low in energy. For some women, the pain can be so severe that they pass out.

Uterine contractions

The exact cause of primary dysmenorrhoea is not known. However, women with this condition have a higher proportion of certain chemicals called prostaglandins in their menstrual fluid. Prostaglandins may cause contractions of the uterus (womb) and pain. Women may also have higher levels of certain hormones circulating in their bodies which are also associated with increased pain.

Women are more likely to have this condition if they are young, have never been pregnant, suffer from depression, anxiety or smoke. Having a mother or a sister with this condition also places a woman at higher risk.

If a young woman thinks that she has this problem she should see her doctor. She will be asked a number of questions and will have a physical exam. In some cases, she will have an ultrasound, in addition to other tests.

Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen often work very well to ease the pain or women may need hormonal therapy, such as the birth control pill. Supplements, as well as other alternative medical procedures, are also sometimes helpful in treatment.

Response to letter

I received this letter a few weeks ago in response to my article on in vitro fertilisation (IVF).

Maybe it's true. But there had been scattered news like this even before as well. And many a people go behind it for some time. Infertility is a subject which is very relative; in majority of the cases it needs only counselling and some pacification then automatically Allah takes care of it.

But if real problems are there you have to treat them. In modern medicine, all the treatments that are now available had gone through controlled studies, so until and unless we do such randomised controlled double blind studies, we can't accept these words.

If you can arrange the materials, I can do the study and publish it more scientifically, even in international journals.

You know I have several publications in international forums, just now I presented a paper in the 13th World IVF conference in Istanbul, last week looking forward.

Dear Doctor,

I certainly appreciate your letter and your interest in research. While I certainly agree about the need for more research, I am not in a position to provide such materials. I encourage you in your pursuits and suggest that you communicate with your local medical board or university regarding your interest.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.