Accra, Feb. 19, GNA - I recall how Nana Ama; my friend, would groan in pain in class whenever it's that time of her month.
We were not bothered by her behaviour as we thought it was normal for any lady to go through such pain when her month was due.
One fateful day, when the class was set and waiting patiently for the teacher, Ama as usual did her thing again, this time snapping her fingers and moaning loudly to draw attention.
I with some colleagues went to her aid, and just when we were about getting her out, she fell unconsciously on the ground.
With the help of some colleagues from other departments, she was put in one of the Army pickups (car) and conveyed to 37 Military Hospital. She was treated and discharged in few hours time.
This unpleasant experience of intense abdominal pain kept repeating itself every month.
Nana Ama was not the only one with that problem, about 30 per cent of us (girls) in that class experienced menstrual cramps, just that ours may not be as severe as hers.
Nana Ama later told me that hers was the severe type. She said none of the pain killer tablets could solely help relieve the pain unless injection.
This involves inserting of a Diclophenac Suppository anally, after which she had to rest for about an hour before she got better.
The question is can she go through this treatment every month? What if there is no one to accompany her to the hospital? What of the cost of the medication?
Today most ladies have this problem of cramps coinciding with their monthly flow, which affects their daily output at home and at the work place.
Those going through such experience can testify to it. You are totally out of yourself when you are going through such intense pain; you become weak hence, you are not able to perform your task to satisfaction.
Since menstruation is coincided with menstrual cramps, let’s take a look at menstruation and how it results in cramps.
Menstruation is the monthly flow of blood in women.
According to the US Department of Health and Human Service, Office on Women’s Health, the act of blood flowing from the uterus through the opening of the cervix and out of the vagina is termed menstruation. Menstrual period mostly lasts from three to six days.
Symptoms of Menstruation
The symptoms includes; swollen/ tender breast, dizziness, diarrhoea, vomiting, mood swings, acne, loss of appetite or craving for food.
Menstrual cycle and its process
The regularity of menstruation period is called menstrual cycle. Menstrual cycle provides essential body chemicals called hormones, which keep the body healthy.
It also prepares the body for pregnancy. The cycle is usually counted from the first day of the period to the first day of the next period. The average menstrual cycle is normally 28 days long.
During the first half of the cycle, the level of estrogen (female hormone) begins to rise making the lining of the uterus (womb) grow and thicken. The lining of the womb is the place that nourishes the embryo if pregnancy occurs. As the lining of the womb is growing, an egg (ovum) from one of the ovaries is produced and starts to mature.
Ovaries are small oval-shaped glands that are located on either sides of the uterus. The egg leaves the ovary in day 14 of the average 28-days cycle and this is called ovulation.
After the egg leaves the ovary, it travels through the fallopian tube to the uterus.
A woman is likely to get pregnant during the three days before or on the day of ovulation if the egg is fertilised by the sperms of a man.
If there is no fertilisation, the egg splits, the hormone levels drop and the thickened lining of the uterus is shed during menstrual period.
The length and nature of periods varies in women, depending on amount of bloodshed. A period can be light, moderate, or heavy in terms of the blood that comes out of the vagina.
The monthly flow is supposed to be normal but it is not so in most women. Some women’s menses are often accompanied by an intense pain, which to some extent is more or less the pain of a woman in labour.
This severe pain coinciding menses is known as Menstrual Cramps or Dysmenorrhea.
So what is a menstrual cramp, what causes it, is there a way to cure it?
Menstrual cramp(s) is the pain felt around the lower abdomen before or during menstruation.
The pain varies depending on the intensity of the pain. It can be moderate or extremely severe. Dysmenorrhea is of two types, namely; Primary and Secondary Dysmenorrhea.
Dr Mary-Anne Zuolo who doubled as a Medical Officer at the SDA Hospital in Tamale and Public Educator of Endometriosis Foundation Ghana (EFG) in an interview with the Ghana News Agency in Accra explained the types of Dysmenorrhea in relation to Endometriosis.
According to Dr Zuolo, the Primary Dysmenorrhea is usually a day pain before or during the menses and has no underlining cause.
This means there is no disease or abnormality in the uterus or pelvis causing the pain. Primary dysmenorrhea can easily be managed with common painkiller drugs.
With the secondary dysmenorrhea, the intensity of the pain is due to some identifiable causes such as Endometriosis, fibroid, pelvic infection, ovarian conditions among others. It also means that there is a problem in the uterus or pelvis causing the pain and if that condition is treated the dysmenorrhea will stop.
The symptoms associated with Secondary dysmenorrhea include, irregular periods, painful sex, and foul smelling vaginal discharge.
Causes of Dysmenorrhea
Dysmenorrhea is caused by a chemical called Prostaglandin. The uterus contracts to turf out the lining when fertilisation does not occur, in the process, hormones called prostaglandins are released, which causes the uterus to contract and cut the blood flow to the lining (endometrium).
It is also caused by Edometriosis, fibroids and others.
What is Endometriosis?
Endometriosis is a condition in which the tissues which are supposed to be inside the uterus are developed and found outside it. The tissue lining the inside of the uterus is called the endometrium, in endometriosis; such tissues which under normal circumstances should be found inside the uterus are located in other parts of the body, especially the pelvic area.
The body responds to this abnormal deposition of tissues by causing inflammation.
The inflammation tries to get rid of the abnormal deposition and that results in the severe pain. Just like the linings in the uterus, these tissues outside the uterus also contract, thicken, cramp and also shed, causing intense pain.
Researches depict that one person out of every 10 women experiences endometriosis and there is no specific age limit for it, once a woman menstruates she can be affected.
According to Dr Zuolo, lots of research is ongoing to find the actual cause of endometriosis. Number of reasons have been mentioned to explain why endometriosis occurs, but so far no single best answer can be given.
Symptoms of Endometriosis
These include dysmenorrhea, infertility, heavy or irregular bleeding, pain during sex, low back pain, pain when passing stool or urinating, bloating and nausea.
There are many more symptoms but these are the commonest and they are usually cyclical and coincide with the menstrual phase.
Endometriosis is not curable but manageable, and effective management is important not just for immediate relief but to prevent complications such as infertility and the psychological torment that the pain brings.
Painkillers, birth control pills/implants can help alleviate symptoms but the best thing to do if a person experience the symptoms, is to see a gynaecologist or a doctor.
The link between dysmenorrhea and endometriosis and why cramps are scary?
Severe menstrual cramps, thus secondary dysmenorrhea is caused by endometriosis and vice versa, and endometriosis leads to infertility, which means it will be difficult for a woman to conceive. This is why menstrual cramps must be treated to avoid future implications.
Treatment and prevention of dysmenorrhea
Some of the prescribed treatments and prevention for menstrual cramps by the Bridge Women’s Clinic in Botswana include; prescribed painkillers, antispasmodics, birth control pills and other hormone treatments.
Other treatments are warm bath, massage or relaxation techniques, vitamin E and treating underlying causes.
Prevention includes: eating of fruits and vegetables, reduce the intake of sweets, caffeine and alcohol. Also, doing acupressure/acupuncture, regular exercise, relaxation and reduction of stress and quitting smoking.
Christielove, a journalist said the cramps she experienced every month varied; sometimes the pain is severe, other times it is mild.
She said this affected her work since she was not able to go to work when the pain was intense. Painkillers and injection is what she rely on to abate her pains.
Dr Zuolo offered this advice: “My advice to all ladies is that not all menstrual pains are normal and to be on the safe side, see a Doctor or a Gynaecologist as soon as possible especially if the pain is severe enough to disrupt your daily life and activities.
“If you think you have endometriosis, ask your Dr about Laparoscopy because it is the only way to confirm endometriosis,” she said.
Dr Zuolo said: “We must also know that endometriosis is not sexually transmitted and although a cure is not yet detected, early treatment prevents complications.”
She noted that not every dysmenorrhea was normal especially the secondary type, “so we must visit the hospital or talk to any trusted gynaecologist anytime our menstruation is coincided with severe pain”.
There are other health organisations like the Endometriosis Foundation Ghana educating, assisting and creating awareness of endometriosis and its implications on people.
They are helping women with secondary dysmenorrhea and endometriosis so people with such problem can see them for assistance.