KARACHI A major cause of lost time from work at child-bearing age, dysmenorrhoea (painful menstruation) affects over 90 per cent of women at one time or another in their lifetime. A majority of these women do not have adequate knowledge of the phenomenon, which is both normal and natural in most cases and can be managed easily.
These were some important points mentioned by doctors during a programme on dysmenorrhoea held at the PMA house on Wednesday.
Briefly explaining the need for organising such a programme, Dr Shershah Syed, the president of the Society of Obstetricians and Gynaecologists of Pakistan, said that women generally lacked correct information about painful menstruation, which was the reason why myths continued to surround the subject.
'Recently I asked a class of postgraduate students about the difference between primary and secondary dysmenorrhoea and, surprisingly, 90 per cent of them didn't know,' he said, adding that cheap but effective medications were available for menstrual pain.
He stressed that mothers or elder sisters who had gone through the experience must educate young girls about it before they reached puberty.
Referring to a survey, he said the absence from work due to dysmenorrhoea caused an annual loss of $2 billion to the United States.
Menstrual pain, he said, could easily be managed with simple medications and changes in lifestyle, and did not need a doctor's expertise.
'The treatment of dysmenorrhoea is not rocket science. Midwives should have the knowledge to deal with this problem,' he said.
Explaining dysmenorrhoea, Dr Nusrat Shah, practising at the Civil Hospital Karachi's gynaecology department, said primary dysmenorrhoea was defined as pain and discomfort during menstruation which occurred during regular ovulatory cycles. While secondary dysmenorrhoea was painful menses which involved an organic cause, for instance the presence of fibroid tumours or cysts.
Twenty to 90 per cent of adolescents, she said, reported menstrual pain while 15 per cent had severe pain. 'The abdominal pain may radiate to lower back and thighs. It can be associated with gastrointestinal and neurological symptoms, for instance nausea and headache. The pain caused by contraction of muscles lasts for eight to 72 hours,' she said, adding that a doctor must be consulted if the pain continued for a longer period.
Vitamins (B1, B6 and E), Omega-3 fatty acid and a high fiber diet were found to have provided relief in menstrual pain, she said. Relaxing techniques such as yoga were also recommended. 'It all depends on what suits you some find relaxation in drinking tea and by putting hot water bottle on the lower abdomen,' she said.
At times, doctors prescribed contraceptives, but their use was for a short period, she added.
Citing an Australian study, she said that 80 per cent women suffered from primary dysmenorrhoea pain that caused limitation in activity in 53 per cent cases.
In a US study, it came to light that only two per cent of teens received information about menstruation from their healthcare provider.
Referring to the myths surrounding menses, doctors said the menstrual blood was pure blood and it should not be considered as 'dirty blood'. There was no risk involved in taking bath during this period as many women believed, they said.
Also, there was no harm in taking good quality painkillers during menses.
'Even if menses stop early due to any medication, there is no harm. In fact, it's good because the woman was losing blood,' they said.
Regarding what should be considered as a 'normal flow of blood', it was mentioned that the normal flow of blood during menses could be from 5ml (a teaspoonful) to 80ml in one cycle.
'I had a patient who told me that she only got a blood stain in a cycle. With this ovulation period, she had four children,' Dr Nusrat Shah told the audience.
Talking about the psychological impact of menstrual pain, Dr Haleema Yasmin working at the Jinnah Postgraduate Medical Centre said that research showed that the presence of menstrual pain impeded the access to pleasant personal experiences.
'There is also a relationship between environmental tobacco smoke and increased incidence of menstrual pain. It has been observed that if you are prone to stress, you are prone to having menstrual pain. Women with a history of dysmenorrhoea also have higher levels of gastrointestinal disturbances during menses,' she said.
Activity scheduling and relaxation techniques were effective ways to manage menstrual pain. According to a research, women placed on low fat vegetarian died experienced significantly less menstrual pain and intensity as well as significantly decreased duration of pre-menstrual syndrome symptoms.
Dr Shahnaz Hussaini and Dr Khaliq-ur-Rehman also spoke.