The medical word for pain with a menstrual cycle is dysmenorrhea. The menses is a destructive event. The lining of the uterus anticipates the implantation of a newly conceived pregnancy. The hormone secreted by the ovary after the mid-cycle ovulation is progesterone and the blood supply of the lining of the uterus becomes addicted to this hormone. This hormone is produced for about 14 days in the majority of women and then the blood level drops drastically. If the pregnancy is created, the developing baby prevents this decline in progesterone.
When the progesterone is withdrawn from the lining of the uterus, it loses its blood supply. Any part of the body denied blood supply dies; and when it dies, there is tissue breakdown, inflammation, bleeding and frequently pain. The uterus does its best to pass this tissue: It does this by contracting its muscular walls and this creates cramps. The hormone most responsible for contraction of the muscle of the uterus is prostaglandin. This hormone is used occasionally by obstetricians to start labor.
One woman's period may vary from another for myriad reasons. First, different people are wired differently; some people tolerate any pain poorly and others are more pain tolerant. The thickness of the lining may vary from month to month in the same woman, giving some variation even within the same woman.
The outflow tract, the cervix, can be such a small opening that the uterus must work harder to drain. There can also be a polyp in the uterus. A polyp is an area of uterine lining that piles up and scars and can not be passed with the normal uterine lining, although the uterine muscle will strain and strain to try to expel it.
Also, some women have endometriosis. This is when the lining of the uterus escapes the womb and gets on bowel, bladder, ovaries and tubes. These structures tolerate the breakdown of this lining, even more poorly than the uterus. Another reason for variation is that the level of prostaglandin production varies between women. The menstrual blood of a woman with severe menstrual cramps has been found to have higher levels of prostaglandin than women with milder periods.
There are several things that can be done to lessen or eliminate dysmenorrhea. An exam by your doctor can evaluate for normal anatomy. There are medications that block the body's ability to make prostaglandin. They are called non-steroid anti-inflammatory drugs (NSAIDs) such as Motrin, Anaprox and Ponstel. They do not generally cause sleepiness and they work best when taken as soon as there is any hint the period is starting. This nips the prostaglandin production in the bud. Beginning anti-inflammatory agents, also decrease the discomfort of pain related to endometriosis. They also have been shown to actually decrease menstrual blood loss.
If these do not help pain, a polyp can be evaluated and removed with a hysterscope, which can look up inside the uterus with fiber optics. Having a dilation and curettage can also reveal a polyp. Using hysteroscopy and either electricity, a hot water balloon or a laser, the lining of the uterus can be burned away to stop the bleeding, this is called endometrial ablation. (WATCH NovaSure VIDEO) Depending on the needs of the woman, her desires for fertility and the level of disruption of her life caused by this pain, a hysterectomy may even be a consideration.
FRED CREUTZMANN, M.D. – CARROLLTON
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