When menstrual cramps affect your livelihood

When Joy reached her puberty, she expected to go through what girls her age go through at that age. Unfortunately, things turned out differently. She did not get her periods until she was 20 years old. For seven years, she tried visiting all the doctors she could think of, but all they told her was that she was normal and just had to be a little patient.

“When my periods finally came, it was a nightmare. I would get severe pains, especially on the first day of my monthly periods. I would get strange pains in my abdomen, throw up, and would even have to get drips. These days, the pain starts a week before the periods begin and go on until a week after,” she shares.
Over the years, she has had one operation, to take out the cyst in her ovary that the gynaecologist attributed to the cause of the pain she feels during her periods. She also has to keep getting the monthly drips, and medication whenever she is in her periods.

Monthly periods are a nightmare for many women, particularly because of the abdominal pains that they suffer during this time. Many women are victim to this, with the extreme cases ending up being hospitalised.
Dr Paul Muwanguzi, a gynaecologist at the Seven Hills Medical Centre, states that painful periods is most common in young women and accounts for most of their visits to the gynaecologist. In Joy’s case, the condition, which is scientifically known as dysmenorrhoea, is in the secondary stage. Secondary dysmenorrhoea is the extreme case of menstrual cramps, and just like in Joy’s case, the victim has a number of infections in addition to the pain.These infections complicate the pain.

“This condition arises at some point in a young girl’s life with 50 per cent of girls in puberty falling victim to this,” Dr Muwanguzi points out. He further explains that the condition is classified into two groups: primary and secondary dysmenorrhoea. He says secondary dysmenorrhoea, in particular, is common in women in their 30’s.

Causes of secondary dysmenorrhoea
Dysmenorrhoea is caused by different conditions. Secondary dysmenorrhoea, which is more unbearable than the primary one, could be as a result of conditions such as, endometriosis, pelvic inflammatory disease (PID), early age menarche (first menstrual period), smoking, fibroids, polyps, or even ovarian cysts. All these infections, when not properly treated, could be a cause of the extreme pain that the victim will feel during their menstrual periods. Endometriosis is a gynaecological condition in which cells from the lining of the uterus appear outside the uterine cavity, most commonly on the membrane which lines the abdominal cavity, the peritoneum. Dr Muwanguzi goes on to explain that this condition not only causes discomforting pain to those that have it, but also distress to the victims.

“In the case of the adolescents, the girl cannot go to school when she is having this pain. If it’s someone that has to work, then she will have to take a few days off work, especially if it is secondary dysmenorrhoea,” he states.
He further explains that the biggest problem here is the cultural definitions of our society, where the women with this condition can’t even talk about it openly.
Dr Mike Kagawa, a lecturer at the department of gynaecology and obstetrics, Makerere University, adds to Dr muwanguzi’s view, saying that the commonest cause of secondary dysmenorrhoea is infections.

“If you get an infection like STI’s, PID, or any other infection that has an effect on your reproductive system, then you are bound to suffer from secondary dysmenorrhoea,” he says, adding: “By nature, the uterus is made in such a way that whatever is inside there, it tries to expel it, and so if there is any swelling, it tries to expel it, through contraction. This is what causes the pain, that you will feel during your periods,” Dr Kagawa points out.

Management and treatment of extremities.
If the cause of the dysmenorrhoea is endometriosis, then it can be treated by surgery. “What would be inside the uterus that causes you to menstruate, which is called the endometria could grow elsewhere, like in your tubes, and so every time you menstruate, the place [where the endometria is] also does the same, and you end up feeling the pain. So this will necessitate surgery to have it removed,” he adds.
Management depends on the diagnosis, after one has visited the gynaecologist. “If the cause of the pain is fibroids, then you will need to get an operation to have the fibroids removed,” Dr Muwanguzi says. He adds that a gynaecological investigation will also be done, for cases of history taking, to establish the patient’s medical history. A laparoscopy may also be done in case there is a PID.

Primary dysmenorrhoea.
Dr Muwanguzi says that in the case of primary dysmenorrhoea, there is pain, and no other organic infection. He emphasises that it is the most common one, among many young women that are having their menstrual periods.
A clear example of the primary dysmenorrhoea is Deborah Mirembe, who explains that during her periods, she get very weak and dizzy, prompting her to even take off a few days from work.

“I get so weak, and feel very lazy to even do anything. However, I also get the pain like other girls although mine is a little mild,” she says. In her case, all she has is the pain, and no trace of any infections.

Dr Muwanguzi goes on to say that the pain in primary dysmenorrhoea, may be as a result of prostaglandin, a hormone that faciltates uterine contraction during menstrual flow. It causes the vessels to constrict, and this is what causes the pain that one feels during their periods. “When the vessels are constricted, the blood supply is cut off, causing its victim to feel the pain,” he explains.

Dr Kagawa says primary dysmenorrhoea can also be as a result of hormonal changes, and many times, if you can reorganise the menstrual cycle, the pain can go away.
For primary dysmenorrhoea, the medical personnel may recommend medical methods such as painkillers, which may include diclofenac and ibuprofen. Dr Musinguzi also recommends a combination of contraceptives. “These will stabilise the hormonal balance and in the long run, stop you from having the pain,” he explains.

On the other hand, Dr Kagawa advises that aside from using the hot water bottle method which seems to be the commonest used by majority of women, one could use the acupuncture method. Acupuncture is a traditional module of treatment that involves a collection of procedures involving penetration of the skin with needles.
“Long ago, people use to say that if someone had dysmenorrhoea and they got pregnant, the pain would go away. But there is treatment for dysmenorrhoea, and so one does no’t have to get pregnant to cure this illness, he says.
For both primary and secondary dysmenorrhoea, Dr Kagawa advises: “... visit a gynaecologist and he will recommend a suitable treatment for you.”

Myths about menstrual Cramps and home remedies
Dr Herman Ssewagudde Musoke, a gynaecologist at Seven Hills Medical Centre, points out some of the myths about the causes of cramps, which are not true
•Witchcraft
•Virginity. There is a myth that its only virgin girls that suffer from cramps.
•Infertility. Cramps have also been attributed to infertility, which is not true.
•Having many sexual partners.
•Poor hygiene
• Use of shared public toilets

Home remedies for relieving cramps
•Hot water bottle
•Hot strong tea but avoid coffee and salt
•Exercise
•Fruits
•Certain foods such as those high in fibre e.g brown rice and brown bread, but avoid fats.
•Herbs e.g parsley and ginger
•Curling up
•Lying on the tummy
•Avoid sugar

How different women manage cramps
“In most cases, I use the hot water bottle. It helps me to calm the pain. I don’t like using pain killers because a friend of mine says they could turn to be addictive. So I prefer to use the water bottle,”
Samalie Muhaye, teacher

“My biggest problem during my periods are the mood swings. I get easily irritated, and annoyed. I don’t really have a lot of pain, aside from a little discomfort here and there. I choose to have healthy foods, and lots of fluids during this period,”
Rehemah Namujju, housewife

“My cramps are usually very bad, that sometimes I will even fall sick. I normally use the diclofenac tablets that my doctor recommended to deal with the pain. The first day is usually the bad one, and I even get nausea,”
Hamidah Nanyiti, business lady

“When I am having cramps, I drink lots of hot fluids like tea, usually without any sugar in it. This helps me feel better, especially with the relief it gives in my lower abdomen. Of course, once, in a while, I may take some panadol, to help with the pain, especially in the first two days of my periods,”
Josephine Nabachwa, counsellor

“I skip a rope whenever I have crumps. The doctor advised me to do so because the body sweats and gets warm and the veins dilate. The pain lessens and I can smile again,”
Beth Kabarungi, researcher

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