Managing Menstrual Pain in Adolescent Girls

A major condition that young girls experience during their adolescence and teenage years is menstrual pain. Most girls call it MP as an abbreviation for menstrual pain among their peers but it is medically known as dysmenorrhoea.


Dysmenorrhoea is the pain that occurs before or during menstruation or both. It is classified into primary and secondary. Primary dysmenorrhoea occurs when the pelvic anatomy and ovarian function are normal and no abnormality has been found to cause the pain.

The exact mechanisms of primary dysmenorrhoea are unclear, but pain has been associated with high levels of prostaglandin in the uterus. This high prostaglandin levels increases uterine muscle contraction, leading to reduction in blood flow to uterine muscles. This occurs more in the teenage adolescent.

Secondary dysmenorrhoea, however, describes pain due to abnormality in the pelvic region. It is not common among the adolescent but most commonly observed in older women who are above 30.

Symptoms

Primary dysmenorrhoea usually coincides with the start of menstruation. The initial onset is usually after first menses. Secondary dysmenorrhoea is rather associated with a later age of menstruation, after years of pain-free menses and the patient is usually above 30 years of age.

The pain begins as a dull pelvic ache three to four days before the menses comes and becomes more severe during menstruation.

Other symptoms that may be associated with secondary dysmenorrhoea include pain during s*x, irregular cycles, heavy bleeding, bleeding in between cycles or after s*x. It should be noted that all these symptoms can also be caused by other gynaecological conditions.

Symptoms experienced may vary in different individuals and these include: low midline abdominal or pelvic pain that may radiate to back or thighs, dull or severe cramping pain which may last up to 12 hours before the menses appease.

Nausea and vomiting, headache, syncope or flushing, psychological distress — anxiety, depression or both — are other signs to watch for.

Diagnosis

Physical examination will include a pelvic examination (an abdominal and internal examination) in order to determine the underlying cause. This will allow the physician to differentiate between primary dysmenorrhoea and other causes of pain associated with a medical condition.

There are no specific tests to diagnose primary  dysmenorrhoea. Specific investigations are ordered based on history, examination findings and severity of pain or other associated symptoms.

Investigations are only important if a secondary cause is suspected or in refractory cases of primary dysmenorrhoea. For patients with the secondary, investigations should be directed to the most likely cause.

Common causes of secondary dysmenorrhoea include endometriosis, uterine fibroids, pelvic adhesions, pelvic inflammatory disease, ovarian cysts, gastrointestinal disturbances and, on very rare occasions,  malignant tumours of the uterus, ovary, bowel or bladder could be responsible for this.

Natural remedies for relief

Turn to tea

Certain teas may help to relieve menstrual cramps, says Sonya Angelone, RDN in the San Francisco Bay Area. Research on herbal teas for menstrual pain relief is scarce, say experts, but teas have been used traditionally and can help. Because some of the herbs may act as estrogens, ask your doctor first before using one, especially if you have a history of a hormone-related cancer or take blood-thinning drugs.

Fish oil, vitamin B1, or a combo of both can significantly lessen period cramp pain.

Tea with peppermint oil may also help, Angelone says. She advises her patients with cramps to start sipping the tea that gives them relief a week or so before they expect their period. Ask your doctor if that might work for you.
Boost endorphins

In addition to their pain-relieving effect, endorphins can also boost your mood. Having an orgasm releases endorphins, Palmieri says.

Working out does as well. Perhaps the last thing you want to even think about while in the midst of cramps is exercise, but that can boost endorphins and help chase away pain.

A report published in March 2015 in the Journal of Family Reproductive Health indicates that both aerobic exercise and stretching helped soothe period cramps for 105 students in the study.

Up magnesium in your diet

Getting more dietary magnesium seems to help ease the pain of cramps, says DeJarra Sims, ND, assistant professor of naturopathic medicine at Bastyr University’s California campus in San Diego and author of Your Healthiest Life Now. Indeed, a Cochrane review of dietary and other remedies published in 2001 concluded that getting enough magnesium can help to relieve pain.

Magnesium is found in many foods and as a supplement if you can’t get what you need from your diet. Magnesium helps to regulate nerve and muscle functioning, among other vital tasks; researchers who evaluated the evidence on magnesium call it a promising treatment for menstrual cramps. But they cannot recommend a specific dose, because researchers have studied various doses. The recommended dietary allowance of magnesium for women of childbearing age is about 320 mg daily. An ounce of dry almonds or one half cup of boiled spinach each has about 80 mg.

Medical treatment

Medical options are still the most reliable and effective treatment for relieving dysmenorrhoea and they include the use of simple analgesics, prostaglandin inhibitors or anti-inflammatory drugs, combined oral contraceptive pills, Vitamin B1 (thiamine).

Anti-inflammatory drugs and COCP are the most commonly used therapeutic modalities for the management of primary dysmenorrhoea.

The health of the girl child, is so important in the adolescence period because of the number of hormonal agents at play. Make it a date with me next week, as I write on a how to prevent young girls from contracting sexually transmitted diseases and cancer of the cervix in the future.