Define, Identify, Overcome: A Complete Guide to Menstrual Pain

“Menstrual cramps, referred to clinically as dysmenorrhea are throbbing or cramping pains that occur prior to or during a women’s period.” The pain ranges from dull and annoying to severe and extreme.

Cramps

featuring Nurse Practitioner Kathleen Hascher

There’s one thing all women know about, and it’s called “that time of the month.” For those who don’t experience extreme pain during their menstrual cycle, having a period is a time for a little bit of extra pampering, savoring food urges, and a good reason to get a massage to ease the subtle physical changes that occur. For some, menstrual pain and severe cramps are a big problem. From the time when girls grow into young women, menstrual cramps can be a debilitating affliction.  Prior to or during their period, some women need to curl into a fetal position and wait for the pain to subside. Since menstrual cramps are something that at least 50 percent of all women will complain of sometime in their life, it’s time to say “Enough of this – let’s try to find a solution!”

According to Mayo Clinic’s website, menstrual cramps, referred to clinically as dysmenorrhea are throbbing or cramping pains that occur prior to or during a women’s period. The pain is produced by an inflammatory chemical that is released when there is a drop in the progesterone level, which happens prior to a women’s period occurring. The inflammatory chemical, called prostaglandins is a bi-product of the process triggering the uterine muscle contractions that help expel the uterine lining each month. Higher levels of prostaglandins are associated with more severe menstrual cramps. In more severe instances, the resulting pain can be compared to the chest pain that occurs when blocked blood vessels starve portions of the heart of food and oxygen during a heart attack.

We asked an expert in menstrual health and well-being, Nurse Practitioner Kathleen Hascher from Grand Rapids Women’s Health, more about this subject. She provided sound advice and important information to Women’s Lifestyle Magazine to share with women who suffer with monthly menstrual pain.

Hascher stated an astounding fact: “The number one reason that girls take off time from school is due to painful periods,” she said. “Many days of valuable school time is lost. This is also a big problem for women who also suffer with menstrual pain every month. Time off from work for them is a big deal and many times results in loss in pay.”

It is reported between 20 and 25 percent of women have significant monthly menstrual pain just prior to or during their periods. This is enough of a reason to not just equate it to an affliction that “a woman must bear.” According to Hascher, there are sound and effective ways to alleviate painful periods.

“There are lots of ways a woman can take care of some of the pain themselves if it is minor, like taking Motrin or Aleve when symptoms first arise. But getting ahead of the pain is key,” she explains. “Once the pain is more extreme, it’s harder to gain control of it.” Natural alternatives to medication can also be followed and used in a similar preventative manner.

If the menstrual pain is more severe and chronic, a trip to the gynecologist may be your best solution for addressing and counteracting what may be a more serious problem.

Women who have chronic and severe menstrual pain may be approached in a variety of ways, depending on their healthcare provider. According to Hasher, Grand Rapids Women’s Health will approach the situation by first discussing Aleve or Motrin as a pain-reducing option, and then suggesting an oral contraceptive. Hascher explains that DepoProbera, an injection that is given every 12 to 13 weeks, occasionally is used to subside pain. Other alternatives include a progesterone-containing IUD such as Mirena, Liletta or Skyla. “All of these prescriptions are based on a patient’s preference and best fit for their specific issues,” said Hascher. “These prescribed methods are the first step toward helping alleviating or significantly reducing menstrual pain.”

MenstrualChartHowever, if in three to six months if there is no significant improvement, further evaluation may be needed to determine if fibroids or endometriosis may be at the root of menstrual pain. Hascher said that since endometriosis can’t be detected in an MRI or CT Scan, a surgery called laparoscopy is often recommended.

“A laparoscopy is a small incision that is made in the abdomen during surgery that allows the physician to look at the entire inner pelvic area to determine whether endometriosis is present,” she said. During the laparoscopy, if endometriosis is detected, it will be removed and the patient would then be prescribed an oral contraceptive to help keep endometriosis from further occurring. After the surgery, DepoLupron is sometimes prescribed for short term use (around a year) to prevent growth of endometriosis tissue, further helping to minimize menstrual pain caused by endometriosis.

“Without the drug, there is often a chance that endometriosis could come back and impact fertility (and pregnancy success), as well as cause future menstrual pain,” she said. “DepoLupron eliminates estrogen production so a woman doesn’t have a period at all. A woman will eventually get her period back after not taking the drug, but it may take months for menses to return. It has minimal risks when used short term and it could actually improve pregnancy success in the future by minimizing endometriosis.”

Hascher continued, “During the patient’s first visit, we’ll also test to make sure that there are no sexually transmitted diseases. Pelvic Inflammatory Disease (PID) is not often known about and if a woman isn’t tested, she could have PID for many years without knowing it.” Annual screening of chlamydia in sexually active females age 26 and under is recommended by the Center for Disease Control. It can be a cause of dysmenorrhea, but may also be silent. It can scar the fallopian tubes and impair fertility as well as cause chronic pelvic pain.

Additionally, Hascher said another reason for menstrual pain could be uterine fibroids (noncancerous growths in the wall), which can be detected through ultrasound. Fibroids happen most commonly to women in their thirties and beyond, but may occur earlier in some women. These can be detected through at MRI or CT Scan. “Removal of the fibroids will often take care of painful periods entirely,” said Hascher.

“Everyone experiences pain differently,” Hascher concludes. “There is no definitive measurable way for healthcare providers to measure a woman’s pain. Women don’t have to suffer. There are tools to help them and we want to work with them to find the best solution for each individual.”


Hascher.Kathleen

Kathleen Hascher MSN, FNP is a Nurse Practitioner at Grand Rapids Women’s Health. Kathleen graduated with a Bachelor of Science in Nursing and a Master of Science in Nursing from Grand Valley State University. She is a Board Certified Family Nurse Practitioner.

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