Menstrual Pain Treatment and Relief Singapore
by: Dr. Tan Hue Min, Family Physician, Regis Medical
Menstrual pain is a common problem faced by women. Around 80% of all women will experience menstrual pain in their lifetime. For 5% to 10% of women, the menstrual pain experienced can be so severe that it interferes with their daily lives.
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Menstrual Pain in Singapore
Menstrual pain is a common occurrence in Singapore as well. In a YouGov research done in 2017, it was reported that 87% of Singaporean women experienced menstrual pain. In addition, among the women who had experienced menstrual pain and was also employed, 78% reported that their menstrual pain had affected their ability to work.
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What is Menstrual Pain?
Menstrual pain, or dysmenorrhea, refers to painful muscle cramps that are generally felt in the tummy that can spread to the back and thighs. The severity and frequency of the pain can vary, sometimes coming in the form of intense spasms or as a dull but constant pain. Menstrual pain may not happen during every period. It can sometimes happen right before your period as well.
Types of Menstrual Pains
Menstrual pain can be categorised into two types: primary and secondary.
Primary Dysmenorrhea
Primary dysmenorrhea refers to menstrual pain that is not caused by any other underlying medical condition. This is the most common type of menstrual pain experienced. During your menstrual period, your uterus will contract to expel its lining. Your uterus may produce prostaglandins excessively, a type of chemical that causes the muscles of your uterus to contract and relax, causing cramps.
Secondary Dysmenorrhea
Secondary dysmenorrhea refers to menstrual pain that is caused by other underlying medical conditions. This type of period pain tends to happen later in life, commonly affecting women in their thirties and forties.
Medical conditions that may cause period pain include:
- Endometriosis. The cells that are similar to the lining of the uterus grow in other places, such as the fallopian tubes and ovaries, causing intense pain when they shed.
- Fibroids. Fibroids are non-cancerous growths that grow in or around the uterus. These fibroids can cause your periods to be heavy and painful.
- Pelvic inflammatory disease. This disease is caused by an infection of the female reproductive system, consisting of the womb, fallopian tubes and ovaries. This results in severe inflammation, causing pain.
- Adenomyosis. The tissues that usually lines the uterus grows into the muscular wall of the uterus. This can cause your periods to become heavy and painful.
Period pain can also be a result of using an intrauterine device (IUD). An IUD is a type of contraceptive device that is inserted into the uterus. For the first 3 to 6 months after inserting the device, your periods may be heavier and more painful.
Risk Factors for Menstrual Pain
Certain factors can increase your risk of menstrual pain during your periods. These include:
- Being under the age of 30
- Started puberty early
- Heavy bleeding during periods
- Irregular menstrual bleeding
- Have a family history of menstrual cramps
- Smoking
When should I see a doctor?
While menstrual pain is a common occurrence, you should visit a doctor if your menstrual pain has become severe enough to interfere with your daily life and ability to carry out everyday activities.
If you experience the following symptoms, you may wish to seek a doctor’s opinion:
- Three consecutive painful menstrual periods
- Passing blood clots
- Cramps that come along with diarrhoea and nausea
- Pelvic pain when not menstruating
- Pain that persists after your IUD insertion
Pelvic pain and sudden cramps could suggest a possible infection. Untreated infections could lead to serious problems, such as damage to your pelvic organs and even infertility.
You should seek immediate medical help if you experience the following symptoms:
- Fever
- Severe pelvic pain
- Sudden pain
- Foul-smelling vaginal discharge
Diagnosing Menstrual Pain
To find out the underlying reasons for your severe menstrual pain, your doctor will conduct a physical examination and take your medical history. A pelvic exam will be included to check for problems with your reproductive system and possible infections.
Imaging tests such as an ultrasound, computed tomography (CT) scan or a Magnetic Resonance Imaging (MRI) test may be required if your doctor suggests underlying causes for your menstrual pain. Based on the results of your imaging tests, a laparoscopy may be necessary. A laparoscopy involves small incisions at your abdomen allowing a fibre-optic tube with a camera at the end to be inserted into your abdomen, allowing your reproductive organs to be observed.
Treatment Methods for Menstrual Pain
Mild menstrual pains can usually be treated at home using self-help measures or over-the-counter painkillers.
Painkillers
Over-the-counter painkillers for menstrual pains and bleeding are usually nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. These drugs lower your body’s production of prostaglandin, which reduces the number of contractions by your uterus, therefore reducing the amount of pain caused by cramps.
Self-help Measures
Self-help measures or lifestyle changes that can help manage your menstrual pain include:
- Heat Therapy. Applying heat to your abdomen and lower back can be effective in alleviating menstrual pains. You can use a hot-water bottle, heating pad, hot towel or even take a warm bath.
- Rest and Sleep. Having sufficient rest and sleep can be effective in reducing your menstrual pain.
- Reduce your consumption of caffeine, alcohol, salt and sugar. This can prevent bloating, which can worsen your menstrual pain.
- Avoid tobacco.
- Massaging your lower back and abdomen can help to reduce pain and discomfort.
- Regular exercise. Women who exercise on a regular basis typically experience less menstrual pain.
- Relaxation techniques such as yoga can help with managing your menstrual pain. Vitamins and supplements. Taking vitamins and supplements can help with your menstrual pain. These include:
- Vitamin B-6
- Vitamin B-1
- Vitamin E
- Omega-3 fatty acids
- Calcium
- Magnesium
If the above methods are not helpful with treating your menstrual pain, medical treatment methods can be considered.
Medical Treatment
Medical treatment for menstrual pain depends on the type of menstrual pain experienced.
For primary dysmenorrhea, your doctor may:
- Prescribe stronger painkillers.
- Suggest the use of hormonal birth control. Hormonal birth control may come in the form of a pill, patch, vaginal ring, injection, implant, or IUD. Hormones prevent ovulation, which can control your menstrual cramps.
For secondary dysmenorrhea, the treatment will depend on the underlying cause of your menstrual pain.
If your menstrual pain is caused by an infection, antibiotics can be prescribed.
If your menstrual pain is caused by endometriosis or fibroids, surgery to fix these disorders can help to eliminate your menstrual pain.
If none of these options are effective in relieving your severe, persisting menstrual pain, a surgical removal of the uterus can be considered. However, this will mean that you will no longer be able to have children and should only be considered towards the end of your child-bearing years or if you do not have plans to have children.
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