Michael Abrahams | The dysmenorrhoea demon

If you are a biological man, think about this. How would you feel if every month, or several times a year, you were incapacitated by pain for days at a time, and along with the pain, you would bleed? How would you feel if this pain would interfere with your work or your daily activities? Can you imagine this continuing for years? This is the reality for many women.

Dysmenorrhoea refers to the pain some women experience in their pelvis or lower abdomen during menstruation. It usually begins at the onset of menstruation and does not last for more than three days. A period is supposed to be, at most, an inconvenience. But for many women, it is torture. Not only is their pain severe, but sometimes it is associated with other symptoms, such as severe bleeding, back pain, anal pain, diarrhoea, nausea, dizziness, fainting and fatigue. Some unfortunate women experience such intractable pain that they visit emergency rooms and doctors’ offices regularly for injectable painkillers to alleviate their pain, as oral medication has little or no effect.

Dysmenorrhoea can occur in the absence of an underlying condition but is often associated with gynaecological disorders, such as uterine fibroids (benign smooth muscle tumours of the uterus), adenomyosis (a condition in which cells from the lining of the uterus are located in the muscle of the uterine wall), and especially endometriosis (a disorder in which cells from the lining of the uterus are found in other locations, including on the surface of the uterus, ovaries and fallopian tubes, and even other organs such as the bladder and bowel). In severe cases of endometriosis, the cells may even be found at distant sites, such as the umbilicus and even the lungs.

SUPPOSED TO FEEL THE PAIN

Unfortunately, many women have been socialised to believe that they are supposed to feel pain. In some cases, dysmenorrhoea has a genetic basis, and some girls grow up and see their mothers writhing in agony while seeing their periods and think it is the norm. They believe that period pain and labour pain are a part of life for women, and they just have to deal with it. But menstrual pain is never supposed to be so severe that it interferes with a woman’s daily activities at home, the workplace or elsewhere.

Severe menstrual pain demands medical evaluation. The management should utilise a holistic approach. There are factors that can intensify period pain and these should be identified if present. For example, depression and stress lower your pain threshold, so managing these issues, if present, may help make a difference. A colleague told me about a patient of his who used to have severe menstrual cramps and was in an abusive relationship. She left the island for a while and, during that time, realised that her periods had stopped being painful.

What women consume can also affect the level of pain they experience during their cycles. Women often tell me that dietary changes make their periods more tolerable. Foods rich in omega-3 fatty acids, such as chia seeds, walnuts, flaxseeds, salmon, herring, sardines, mackerel, oysters, edamame beans, and fish, cod liver, algal, krill, flaxseed, soybean and canola oils, have been found to decrease the pain associated with menstrual cramps, by decreasing inflammation associated with the process.

OMEGA-3 FATTY ACIDS

Like omega-3 fatty acids, vitamin D also helps to reduce substances in the body such as prostaglandins, hormone-like compounds that control several processes, including inflammation, pain and uterine contractions. Incorporating foods rich in this vitamin can reduce the pain associated with menstruation. Such foods include trout, salmon, tuna, mackerel, and fish liver oils. The body can manufacture vitamin D when exposed to sunlight.

Foods rich in vitamin E, such as seeds, nuts, spinach, broccoli, kiwifruit, mango, and tomato, can also help reduce dysmenorrhoea. In addition to eating these types of foods, taking supplements with the above-mentioned nutrients can also be beneficial. Magnesium supplements may also prevent dysmenorrhoea by relaxing the smooth muscle of the uterus and, like vitamin D, by reducing the production of prostaglandins.

On the other hand, some types of food worsen menstrual cramps, such as highly processed foods, caffeine and alcohol. If the pain is severe and persistent, drug treatment such as painkillers or hormonal preparations may be necessary; and if there is an underlying disease, surgery may be indicated.

An aspect of dysmenorrhoea that has not been adequately addressed is the impact on production at the workplace. Many underestimate the trauma that some women endure every month or periodically throughout the year. Employers need to allow flexible working hours, working from home or shift modifications to accommodate women who are so afflicted. Painful menstrual cramps should not interfere with a woman’s income.

If you are reading this and have period pain that is negatively affecting your quality of life, please seek medical attention. Periods are a natural process and are not supposed to torment you. No woman deserves that.

Michael Abrahams is an obstetrician and gynaecologist, social commentator, and human-rights advocate. Send feedback to columns@gleanerjm.com and michabe_1999@hotmail.com, or follow him on X , formerly Twitter, @mikeyabrahams.