What's the remedy for very painful periods?

Dr Flo,
I have been having very painful periods ever since I started menstruating. I have tried painkillers and the hot water therapy (put on one’s abdomen), which do not work. The pain is usually severe on the first and last days of my periods. It is usually accompanied by vomiting and fevers. Is there anything that can be done to ease the pain?
TN

Dear TN,
Painful periods are referred to as dysmenorrhoea. There are two types - primary and secondary. Primary dysmenorrhoea occurs due to spasms or contraction of the uterine wall during menstruation and also due to release of some chemicals called prostaglandins and leukotrienes.
It starts within the first few years after the beginning of periods, and it affects almost half of all women. It may also be accompanied by nausea, vomiting, diarrhoea, bloating, headache, dizziness and fever. Secondary dysmenorrhoea occurs due to an underlying problem such as fibroids, endometriosis or pelvic disease.
It starts later in a woman’s life and 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 medicine to manage the pain and 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.
It would be advisable for you to be reviewed by a gynaecologist for proper management. Any underlying problems like fibroids, endometriosis among others should be managed.

Dr Flo,
My leg swells sometimes although it is not painful. I have been having check-ups with no improvement.
CM

Dear CM,
The swelling may be due to oedema, which is accumulation of excess fluid under the skin or in between the tissues. It can happen in the feet, around the ankles, the legs, hands and arms, and even in other spaces within the body like around the brain, the heart, the lungs and in the abdomen. It may be acute, developing quickly, and also resolving over a short period of time.
This can be caused by spraining an ankle, infection, blood clot, bee or wasp sting, allergic reactions and worsening of kidney or heart failure. It can also be chronic, developing over time and lasting a long time. This can be caused by problems with blood flow, or draining of lymphatic fluid, heart failure, kidney disease, liver disease, thyroid disease, low blood level or a growth in the pelvis. You can also have swelling due to underlying inflammation for example due to infection or arthritis.
As part of examination by a health professional, you can have a Doppler ultrasound done. This is a scan that checks the blood flow within the veins. Other tests include checking the heart, kidneys, liver, thyroid, blood level and a pelvic ultrasound scan to check for swellings/tumours in the pelvis. In some women, especially between 20 and 30 years of age, there may be no identifiable underlying cause.
Management involves increased leg exercise, elevating the legs, reducing your weight if you are overweight, reduced salt and excessive fluid intake, and avoiding prolonged sitting or standing in one place. Compression stockings or pneumatic compression devices may be used to improve blood (or lymphatic) flow. If there’s a tumour in the pelvis or any other medical problem, it should be attended to.

Dr Flo,
I have premature ejaculation and I always feel embarrassed whenever I have a sex with my girlfriend. How can I stop this?
DKN

Dear DKN,
The normal male sexual response cycle involves desire, arousal, plateau, ejaculation and resolution. The average time from beginning of intercourse to ejaculation is five minutes. If ejaculation happens sooner than you or your partner would like, it is called premature ejaculation. If it happens once in a while, then it is not a cause of concern.
If it is frequent and is causing frustration, then it needs to be addressed. It can occur due to psychological and physical factors. Psychological issues include traumatic early sexual experiences, worry about sexual performance, anxiety, depression, guilt, poor self-image or relationship problems.
Physical factors include abnormal levels of hormones or brain messengers (neurotransmitters), or inflammation of the urethra or the prostate.
To manage it, any psychological issues need to be addressed, if necessary, by visiting a mental health professional. You also need to have a supportive partner. There are medications that can be prescribed and topical creams that can be used that have a numbing agent.
Other ways of managing it include:
Firstly, avoiding sexual intercourse for some time and focusing on other forms of touch to reduce the pressure to perform.
Secondly, strengthening the pelvic muscles using kegel’s exercise - tighten the muscles that you would use to stop urine flow. Contract these muscles 10 times and repeat at least three times a day.
Thirdly, the stop-start technique - during intercourse, when you feel the urge to ejaculate, stop all activity until the urge passes, then start again. By repeating as necessary and some practice, holding off ejaculation can become a habit.
Fourthly, the pause and squeeze technique - during intercourse, when you are about to ejaculate, have your partner squeeze the penis where the head joins the shaft for several seconds, until the urge passes, then continue.
Lastly, using a condom to reduce sensitivity.

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