How to relieve menstrual disorders, by doctors

Medical experts have recommended conventional and natural remedies to prevent, ameliorate and treat painful periods. Senior Lecturer/Honorary Consultant at College of Medicine at the University of Nigeria (CMUN/University of Nigeria Teaching Hospital (UNTH), Enugu, Dr. Ngozi R. Dim; and a Professor of Radiation Medicine, director of UNN Centre For Clinical Trials (UNNCECT), Convener of African Clinical Trial Summit and African Clinical Trial Consortium (ACTC) and Chairperson, Association For Good Clinical Trials In Nigeria (AGCPN), Prof Ifeoma Okoye, in separate interviews with The Guardian provided answers.

What is menstrual period?
Menstruation is the monthly shedding of the inner lining of a woman’s uterus or womb. It is a part of the monthly menstrual cycle and is a normal process that females go through as their bodies prepare themselves for potential pregnancy in future.

What are menstrual cramps and their causes?
Menstrual cramps are lower abdominal pains usually occurring before or during one’s menstrual period. Menstrual cramps feel like a throbbing or cramping pain in the lower abdomen; it may also feel like pressure or a continuous dull ache in this area. In severe cases, the pain may radiate to your lower back and inner thighs.

This pain normally occurs during menstrual period when the uterus contracts to help expel its inner lining (the endometrium). There are hormone-like substances (prostaglandins) involved in the pain, and the inflammation triggers the uterine muscle contractions. The higher the levels of associated prostaglandins, the more severe the menstrual cramps, as the contraction affects the muscle walls of the uterus. Some women will have mild cramps; others can have severe pain, especially if there are other underlying conditions, apart from the period, that causes a problem in the uterus, worsening the intensity of the cramps. Such conditions include endometriosis, uterine fibroids, pelvic inflammatory diseases (PID) from sexually transmitted infections (STIs), adenomyosis, and narrowing of the cervical canal (stenosis).

How can a lady tell if the pain of her menstrual cramps is normal?
The cramps usually begin a day or two before menstrual periods or at the start of bleeding, peaking around 24 hours after the period starts and reduces two or three days later.

At what stage can a lady contact a health care provider about menstrual cramps?
When a lady has severe or unusual menstrual cramps, or cramps that last for more than two or three days, she should contact her healthcare provider. It’s important to get checked as both primary and secondary menstrual cramps can be treated. Other situations that will necessitate a visit to the doctor include: when menstrual cramps disrupt the woman’s life every month; if symptoms progressively worsen and if severe menstrual cramps started after age 25

What are the risk factors of menstrual cramps?
Risk of having menstrual cramps include – age younger than 30. Normal menstrual cramps are called primary dysmenorrhea and recur with each menstrual cycle. The pain ranges from mild to severe, occurring in the lower abdomen, back or thighs.

Other symptoms, such as nausea and vomiting, fatigue, and even diarrhoea may also occur. Primary dysmenorrhoea tends to lessen with age and improves or entirely stops after giving birth, for most women. They may have a family history of menstrual cramps, but usually do not develop any complications due to the cramps.

Whereas, menstrual cramp from other conditions (as listed above) are called secondary dysmenorrhoea. The pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than normal menstrual cramps. Nausea, vomiting, fatigue or diarrhoea usually does not occur. Other risk factors are: started puberty early, at age 11 or younger, heavily bleeding during periods (menorrhagia), irregular menstrual bleeding (metrorrhagia), family history of menstrual cramps (dysmenorrhea) and smoking.

What can you say about seeing periods twice a month?
The average number of days a woman’s period usually occurs is every 28 days, but normal menstrual cycles can range from 21 days to 35 days. When periods occur twice in a month, it means the periods occurred less than 21 days. This is considered abnormal, but may not be unusual. If it happens more than once or twice, a doctor should check the person. This is important as several things can cause bleeding between periods, such as changes to hormones levels often seen with stress, use of hormonal contraception or contraceptive devices, gaining or losing significant weight, pelvic inflammatory disease, Endometriosis, polyps or fibroids in the uterus, an injury or even cancer.

What are the reasons for less bleeding during period?
A little lighter bleeding than normal initially doesn’t cause concern for many women. However, when this occurs for more than one month or worsens, its good to see the doctor, as some health problems may be the reason for the light flow. The first thing to rule out is pregnancy, as some women, rather than having no bleeding, observe little bleeding even when pregnant. Sometimes, this could be an early sign of an ectopic pregnancy. When in doubt, please take a pregnancy test.

Gaining or losing significant weight can cause hormonal imbalance or put your body into stress mode, resulting in less bleeding. Other causes include – excessive exercise; experiencing major life stressors like loss of a loved one, depression; using hormonal birth control methods; an overactive thyroid (hyperthyroidism); early signs of menopause; Polycystic Ovarian syndrome. Women who have noticed this soon after excessive bleeding after delivery or having a complicated Dilation and Curettage (D&C) which heals with fibrosis/ scarring; cervical stenosis can also cause this problem. Whatever the case; meet a doctor to help find the cause.

How long is the average period?
The average number of days a woman’s period usually occurs is every 28 days, but normal menstrual cycles can range from 21 days to 35 days.

How common is menstrual pain?
It is very common, especially with younger females less than 30 years. Actually, more than half of women who menstruate have some pain for one to two days, each month. Usually, the pain is mild; but the need for medication occurs less frequently. But for some women, the pain is so severe that they are unable to do their normal activities, sometimes for several days every month and require medication or other interventions.

What are the natural remedies that can help relieve period cramps?
Natural remedies, which you can do at home, to ease off menstrual cramps include:
– Drink a lot of water to reduce bloating, which often occurs during menses, increasing the pain.
– Taking herbal teas that have anti-inflammatory properties and antispasmodic compounds, which reduce muscle spasms in the uterus, reduce cramping. Chamomile, fennel, cinnamon or ginger is easy, natural herbal tea that can also have other benefits like stress relief and helping with insomnia.
– Eating anti-inflammatory foods can help promote blood flow and relax the uterus. These include berries, tomatoes, pineapples and spices like turmeric, ginger or garlic; Leafy green vegetables and fatty fish, like salmon, can also help reduce inflammation.
– Avoid foods high in sugar, trans fat and salt, which can cause bloating and inflammation that makes muscle pain and cramps worse.
– Caffeine constricts the uterus, making cramps more painful. Switch to decaf during your periods.
– Dietary supplements like Vitamin D with Calcium, omega-3, vitamin E and magnesium can help your reduce inflammation.
– Applying a little heat can help muscles relax, improve blood flow and relieve tension. Try sitting with a heating pad, taking a hot shower or relaxing in a hot bath.
– Gentle exercises release endorphins that make people feel happy reduce pain and relax your muscles. Fifteen minutes of yoga, light stretching or walking might be all you need to feel better. Research shows those who did 30 minutes exercise, three days a week for at least eight weeks had reduced menstrual cramps.