Many women suffer from menstrual cramps extreme enough to confine them to bed, but treatment is available that can provide effective relief.
Two weeks ago 35-year-old Thando Sibanda* lay motionless in her Hillbrow apartment as wave after wave of blinding period pains tore at her womb, leaving her feeling dizzy and nauseous.
The Johannesburg-based mother of two could hardly move as the pains she had experienced intermittently for more than 10 years intensified.
“My whole abdomen feels like concrete – I feel like suffocating and gagging on my own vomit,” she said. “When it’s time for my period I literally can’t do anything but spend the day in bed.”
According to gynaecologist and obstetrician Bronwyn Moore, chronic pelvic pains associated with menstruation are known scientifically as dysmenorrhoea. “They are characterised by cramping lower abdominal pain.”
Nearly 75% of women worldwide suffer from dysmenorrhoea, according to a 2012 article published in the British Journal of Clinical Pharmacology on treatment for the condition.
Moore said the symptoms vary in intensity among different women.
During ovulation a hormone called prostaglandin, known to cause cramping abdominal pains, is released and affected women “experience mainly lower back pain while some describe pain that goes down into their legs”, she said. “The pain is felt when the uterus contracts to expel the blood, it is very uncomfortable.”
Dysmenorrhoea can cause a significant impairment in a woman’s quality of life and daily functions, said Moore. “The sad bit is that it is not considered something that is worth spending time on or paying attention to, and yet can be very disruptive to a woman, at school or at work,” she said.
Sibanda said it is a misunderstood condition, often dismissed as normal for women.
“People do not understand it, especially in workplaces. They often think you are being funny or lazy or just a crybaby if you ask for a few days off to deal with the condition,” she said.
Childbirth often lessens symptoms
Moore said there are two types of dysmenorrhoea: “There’s the commonest one called primary dysmenorrhoea, which has no real known cause. The second is caused by some underlying conditions like fibroids, cysts or previous pelvic inflammatory diseases.”
Young girls, noted Moore, are likely to get primary dysmenorrhoea when they first start menstruating but this normally improves with age or childbirth.
“Pregnancy and delivery causes the cervix to stretch and dilate and so it’s easier for the menstrual blood to pass and the pressure in the uterus eases,” she said.
Sibanda, however, had her first period pain after giving birth to her first child. Like many other women who suffer from this condition, she was unprepared for the pain.
“My whole pelvic region was in turmoil, like I was going into labour, yet [I was] not pregnant. I was also feverish and a bit disoriented,” she said.
‘Underlying medical condition’
According to Moore, in Sibanda’s case “it’s most likely that there is an underlying medical condition that is causing her to have these pains after childbirth”.
A clothing designer in Johannesburg, Sibanda said her work is often affected, as every month for a day or two she spends the day huddled in bed managing her condition.
“My work is very demanding and I need to be on my best form in order to produce fabulous designs for whatever special occasion,” she said.
“I have seen colleagues with worse conditions: some even vomit and crawl to the bathroom because of the pain,” said Sibanda.
Moore said this is avoidable, however, as there many treatment options available.
“But before one can prescribe any treatment it is prudent to go into counselling sessions with the patient just to let them understand the condition better,” she said.
Treatment options available
For those with primary dysmenorrhoea, said Moore, a few lifestyle changes and moderate exercises were mostly sufficient to manage the condition.
A study published in a 2012 edition of South African Journal of Obstetrics and Gynaecology also noted that many women with primary dysmenorrhoea reported that exercise provided symptomatic relief.
“General exercising improves your blood flow, improves your ability to deal with pain, you release endorphins which are your brain’s own morphine-like hormones to help you deal with [the] pain,” said Moore.
For severe cases, however, she said one needed to take pain medication like nonsteroidal anti-inflammatory drugs or in worse cases, surgical intervention.
The nonsteroidal drugs, according to the 2012 British Journal of Clinical Pharmacology article, restrict or block the production of prostaglandins and include the common painkillers aspirin, naproxen, ibuprofen and mefenamic acid.
“There is also the contraceptive pill, which is used to reduce the amount or time that you bleed and makes a period less painful,” she said.
Moore said awareness of available options was critical, especially for young girls reaching puberty. “The truth is women shouldn’t have to take two or three days off per month from their studies or from their work, there is perfectly adequate treatment available.”
*Not her real name