Dysmenorrhoea means painful menstruation. This is perhaps the most common problem affecting nearly 80% of women in their reproductive years. Fortunately for most women dysmenorrhoea is mild, easily tolerated and is just a sign of normal menstruation while for others it can be quite significant, requiring intake of medicines. In a minority of women it may be a sign of serious disease. Painful menstruation raises many questions.

1. Why it occurs ?
2. Is their an underlying disease ?
3. What is the treatment ?
4. How long will it continue ?
5. Does it affect reproduction ? etc. etc.
    

?Normal? painful menstruation

          Some mild to moderate pain accompanies 60% - 80% of normal cycles. It is a sign of normal ovulation and fertility. A pain which can be ignored or relieved with one or two tablets of analgesics, rest or other symptomatic treatment is generally not harmful.

 Onset

          Menstrual cycles, when they start at menarche are often without ovulation and there may be no pain. With the maturation painful menstruation may start. This is quite normal and rather a good sign. Usually pain decreases with age and after childbirth.

Cause of pain
          The exact cause why normal periods are painful is not known. Many theories have been put forward but non-explains it clearly.

Danger signs

          The borderline between normal pain and abnormal pain is generally quite clear but some times it may be blurred. Following signs may warn you of the possibility of some underlying disease.

1. Very severe pain requiring more than 8-10 tablets or use of injections for relief of pain.
2. Pain not confined to menstrual days.
3. Pain for more than 5 days per month or progressive increase in intensity and duration of pain.
4. Secondary onset of pain in later years of life.
5. Pain associated with heavy bleeding, vaginal discharge, fever or feeling of lump.
6. Pain during sexual intercourse after a normal sex life.

Test Required

          Normally no tests are required to distinguish between normal pain and abnormal pain except for a careful history and examination by a qualified gynecologist. An ultrasound is a very useful test to reassure an anxious patient and her parents in case of young girls more often another future test would be required depending upon whether any underlying disease is suspected or not.

Treatment

          The most important is to have a positive attitude. Menstruation is a normal phenomenon and does not require any special precautions apart from personal hygiene. One or two tablets taken to relieve pain will do less harm than missing a school or office day or lying in bed. Restriction of physical activity only increases the feelings of shame, helplessness and inferiority in young girls. In severe cases a gynecologist should be consulted.