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Dysmenorrhea – A pain that reaches global

Dozens of articles have been written about dysmenorrhea but this article focuses on the “why” of painful menstruation cramps, its prevalence among Filipino women and the local alternative methods of treatment that may or may not be effective in the relief of one of women’s persistent biologic issues.Filipina in dysmenorrhea pain

To me, menstruation is 3D: dysmenorrhea, discomfort, and debility. Every 15th of every month, I feel like being punished for simply being a woman. The rest of the month I’m usually careless with my activities but when my breasts starts to grow tender and I’d feel my back starting to tire, it’s a beep that the inevitable day is coming again. This is why I chose to write this article, because I know millions of women who have the same concern. It’s not just individual, it’s not just local, it’s global.

THE BASICS

DYSMENORRHEA in common term is painful menstrual cramps (the term cramps alone may not be necessarily painful) classified as either primary or secondary.Secondary dysmenorrhea is the type with an organic cause such as endometriosis, adenomyosis etc. This requires careful examination to rule out or establish.This article however focuses on primary dysmenorrhea and is thus defined.

Primary dysmenorrhea is painful menstrual cramps without any evident pathology. That is, history taking would be consistent with the following:

  • onset usually less than 6 months to 2 years
  • lasting 1-2 days, most painful on the 1st and 2nd day
  • characteristically spasmodic, fluctuating type of cramping
  • no abnormal findings in pelvic examination
  • pain may radiate to the back, thigh and labia majoraand be accompanied by dizziness, headache,nausea, vomiting ,diarrhea and loss of consciousness with extreme pain

THE PAIN ETIOLOGY

Let’s first talk about Prostaglandin. The word may not sound gibberish to many nowadays as this is mentioned in a frequently aired TV advertisement of a certain pain medication.

This hormone is present in every cell of the human body performing key roles in inflammation, heart function and blood pressure, allergic response, gastrointestinal function and secretions, pain and swelling, kidney function and fluid balance, nerve transmission, blood clotting among others.

In focus here is its role in inflammation, pain and nerve transmission. In the reproductive system, one of its kind, Prostaglandin F2a is produced as menstruation begins (specifically, when a part of the uterus called endometrium begins to slough off). Its level is thus high in the blood for the first 2 days of menstruation. This PGF2α stimulates stronger contractions of the muscles in the uterus constricting the blood supply to the surrounding tissues, lowering their oxygen and thus causing painful cramps.

THE LOOPHOLE

If prostaglandins are released during endometrial sloughing, why isn’t there pain usually 6 months to 2 years after menarche?

The answer lies on the female ovum or egg which women harbour in thousands inside the uterus. Prostaglandins are released during menstrual cycles in which the ovum or egg is released. In the first months to 2 years of menstruation, the egg may not be released in all the cycles, that is, the cycles may be anovulatory and thus also painless.

Women who have never had dysmenorrhea in the course of their menstrual life, we may say to be lucky. The reason behind is something that is not so meticulously explained, which is why dysmenorrhea was formerly known as “the mystery in Gynecology”. However studies would back up that compared to their polar opposites, women with primary dysmenorrhea simply have increased activity of their uterine muscles because of the production of F2a which is 7x higher.

IN PAINFULLY HIGH NUMBERS

Global statistics show that 50 % of women experience dysmenorrhea. I did my Math and came up with a number. If that were to be applied in the Philippines with an almost 1: 1 male to female ratio (49 % women) and a population of 103,775,002 in 2012, then it can be derived that roughly 25.4 million women suffer dysmenorrhea in various degrees.Multiply with a 1.98 population percentage change to make it even more recent. To some women, this condition may seem like a walk in the park but to the 15 % others, it can be debilitating. It affects individual, family and society at large creating a global concern. But not many women are so apt about pharmacologic treatments or methods of pain relief with the ever growing concern for side-effects and long-term repercussions. That is why…

THE COMMON FILIPINO PRACTICE 

Filipinos hold a very diverse and rich culture. Our practices are influenced by a myriad of cultural interactions – that is, Spanish, Japanese, Chinese and American among many others. However, some practices came out as an outcome of individual experiments a.k.a accident. In almost all aspects of life, we have a certain belief that has been taught to us by our dear elders. Let us explore some of those that relate to dysmenorrhea. (These practices were gathered from fora I visited in the internet (traditional and modern) as well as from elders I know who still hold traditional beliefs and practices.

  1. OTC Pain Medications (Mefenamic Acid, Naproxen Sodium, Ibuprofen) (proven)
  2. Drinking Coca Cola (evidence: poor)
  3. Drinking plenty of water (evidence: poor)
  4. Avoiding salty food (evidence: poor)
  5. Drinking alcohol (evidence: poor)
  6. Herbal Supplements (evidence: poor)
  7. Fish Oil (evidence: poor)
  8. Sex (evidence: poor)
  9. Masturbation (evidence: poor)
  10. (evidence: poor)
  11.  Lifting the suprapubic area after a bath (evidence: poor)

(My purpose here is simply to collect common Filipino women’s management of dysmenorrhea.)

SEEING SAFE ALTERNATIVES

I’ve always been on the lookout for safe alternative methods of ridding myself of this monthly pain. I know pharmacologic methods of treatment are effective in pain relief for primary dysmenorrhea as I use at least one every month, but as I know that many women would rather suffer than pop one, it’s helpful to be exploring alternatives. The following are more studied methods of dysmenorrhea management that I’ve taken from motley of sources printed below this article.

  1. TENS or Transcutaneous Electrical Nreve Stimulation – raises the threshold for pain signals and stimulates release of endorphins, man’s natural pain-killers.
  2. TOPICAL HEAT APPLICATION – Continuous, low-level, heat-wrap therapy applied to
  3. the suprapubic region is proven to be as effective as some pain relief medications
  4. EXERCISE – exercise is known to increase production of endorphin in the body thus diminishing stress and its many biologic manifestations
  5. ACUPUNCTURE – this is a method of traditional Chinese medicine that has long been used in the treatment of many symptoms
  6. FIBER-RICH FOODS – prevents constipation that can aggravate menstrual pain
  7. AVOID GLYCEMIC FOODS – Glycemic foods are known to increase the level of inflammatory chemicals in the body including PGF2.
  8. AROMATHERAPY – the proper aroma (i.e. lavender, chamomile etc.) induces relaxation thus diminishing pain
  9. HONEY – A research in Kashan University of Medical Sciences, Kashan, I.R. Iran published in Life Science Journal 2013 shows that pure honey can significantly decrease painful menstruation because of its spasmolytic property. The research recommends continual consumption of pure honey to prevent dysmenorrhea.
  10. YOGA -works on the whole being of an individual thereby bringing a harmony between the body and mind. Strengthening of weakened muscles and correction of faulty postures is an
  11. established pain relieving method.
  12. SELF FERTILITY MASSAGE – have this done only by expert massage therapists with training in fertility massage. It works by strengthening weak uterine muscles as well as positioning tilted uterus.

Image credit: (1)

  • References:
Porth, C.M. (2002). Pathophysiology. Philippines: Lippincott Williams and Wilkins. http://www.yourhormones.info/hormones/prostaglandins.aspx http://www.aafp.org/afp/1999/0801/p489.html http://obgynresidents.stanford.edu/documents/dysmenorrhea.pdf http://www.medindia.net/symptoms/painful-menstrual-periods.htm http://www.acog.org/~/media/For%20Patients/faq046.pdf?dmc=1&ts=20130817T0043051056 http://www.lifesciencesite.com/lsj/life1006s/132_15981life1006s_835_841.pdf http://www.affordablecebu.com/load/philippine_government/total_population_of_the_philippines_2012/5-1-0-3004 http://www.lifesciencesite.com/lsj/life1006s/132_15981life1006s_835_841.pdf http://natural-fertility-info.com/painful-menstruation-natural-remedies.html

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About Pauline Dominque Tarrazona RN, LMT

The author is a registered nurse and licensed massage therapist who loves words and nature. She hopes that with her writings, she can open the minds of the youth to look underneath the grandeur's of today's modern world to the real needy world/earth beneath it.

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