Are painful periods normal?

Dr Flo,

One of my friends keeps saying that it is not normal to have cramps or pain during periods.

I think the pain is normal because it means the uterus is contracting, and can be managed with painkillers. I used to have bad cramps myself and often had to get injections to relieve the pain, but not anymore.

When I gained 10 kilos taking me from underweight to normal weight, my flow became lighter and the cramps disappeared.

Is being underweight linked to heavy painful periods, and is my friend right that women are not supposed to feel any pain during menses?

Pauline

Dear Pauline,

Painful periods are referred to as dysmenorrhoea and happen either as primary or secondary dysmenorrhoea.

Primary dysmenorrhoea occurs due to spasms or contraction of the uterine wall during menstruation and also due to release of chemicals called prostaglandins and leukotrienes. It starts within the first few years after the onset of periods, and it affects almost half of all women.

Secondary dysmenorrhoea occurs due to an underlying problem e.g. due to fibroids, endometriosis or pelvic disease. It usually starts later in a woman’s life and an underlying cause will be found upon examination or after doing a pelvic scan. Treatment of the underlying problem will usually get rid of the pain.

Severe dysmenorrhoea may be associated with longer, heavier periods, early age of onset of periods, family history of severe pain during periods, smoking, and obesity.

Treatment involves use of medicine to manage the pain and to  reduce the uterine contractions.

Other measures that may help include physical activity, warm compresses and getting enough sleep.

If the discomfort is very severe, oral contraceptives may be used. Pregnancy and giving birth may affect the severity of the discomfort in later cycles.

Being underweight is actually associated with irregular, lighter and sometimes absent periods, while obesity is associated with heavier, more painful periods because of extra production of oestrogens.

******* 

Dr Flo,

I am a keen follower of your column and I like the answers you give to people with various ailments.

I am 52 years old and I am hypertensive. I take Nifelat and Cardace. Recently I felt a sharp pain in the middle of my chest that lasted between three to five minutes, then disappeared. I have felt this pain three times now.

When the pain comes, I feel as if there is a heavy load on my shoulders. It also feels as if the pain is coming from inside my oesophagus, but I’m not sure. I don’t have ulcers and I haven’t had any other issues.

What could this be?

David

Dear David,

Chest pain can be caused by a problem with the lungs, the heart, the oesophagus, the muscles, the bones or even the nerves in the chest.

Due to your age, the history of hypertension and the fact that the pain comes for a few minutes at a time, accompanied by a feeling of a heavy load on your shoulders, it is likely that there may be a problem with the heart.

In many cases, that kind of pain is also accompanied by difficulty in breathing, and occasionally, a cough.

The pain may also be in your oesophagus because it is in the middle of the chest and when it comes, it is sharp and brief.

It would be advisable for you to visit a doctor as soon as possible for a proper check-up. The heart should also be checked using an ECG (electrocardiogram).

Other tests may be done depending on the findings. It would not be advisable to self-medicate; go to a doctor to find out the exact cause of the pain and start on appropriate treatment.

*****  

Dr Flo

My mum has a problem with one of her legs.

She had an X-ray done and was told that there are some things growing in her leg, and the only way to cure them is through exercise and painkillers. Have you ever encountered such a problem and what’s the best way to deal with it?

Mathew 

Dear Mathew,

While it may not be possible to determine in this forum exactly what growths your mum has, because they were diagnosed from an X-ray film, they are likely to be bone growths. This is because soft tissues like muscles, ligaments and tendons do not usually show on an X-ray film.

The bone growths that are usually associated with pain, and do not require treatment other than painkillers and exercise are bone spurs.

Bone spurs are growths or protrusions at the edges of bones that develop after repeated strain on a particular bone or joint. They are also called osteophytes, and they can occur on any bone in the body, but they are more common along the spine at the neck and lower back, at the shoulders, the knees, the fingers and also the heels.

 Because they usually develop over many years of strain, they cannot be cured completely or reversed. The best way to manage them is to avoid activity that would worsen the pain, wear comfortable shoes, use medication to reduce the pain and inflammation, and also consider going for physiotherapy.

If the pain is too much, then steroid injections can be given at the specific site. Surgery is usually a last resort, depending on the specific site and the severity of the condition.