Pain and periods and pre-menstrual-syndrome

A very welcome and much needed breeze of common sense has recently been wafted through the medical and gynocological fields. It is pointed out that there is no justification for the old idea that "it is all in the mind" and that there is no real scientific evidence for such a claim. Indeed, all the scientific evidence that exists points to a hormonal imbalance.

The idea that period pains, or dysmenorrhea, are purely psychological was put forward because there were no abnormalities to be detected on full physical or gynecological examination, nor are there any suitable tests of hormone levels which can distinguish those who suffer once a month. However, gradually it is being realized that dysmenorrhea is due to an imbalance of hormones.

There are two quite different, and indeed opposite, types of dysmenorrhea. There is spasmodic dysmenorrhea which is characterized by spasms of abdominal pain, and congestive dysmenorrhea in which there is congestion of water or rather water retention. This latter type has all the characteristics of the pre-menstrual-syndrome with the addition of period pains.

SPASMODIC DYSMENORRHEA - When menstruation first starts at puberty no ovulation occurs nor is there any period pain; however about two years later ovulation commences and then spasmodic dysmenorrhea also begins. Often at the beginning ovulation does not occur every month, but possibly only on alternate months, so period pains will only occur on alternate months. Spasmodic dysmenorrhea is most frequent between the ages of 15 and 25 years. It ends abruptly after a full term pregnancy, or it may gradually end with each period becoming less painful during the early twenties. The girl usually feels very well during the premenstruum and than is suddenly doubled up with severe spasms of pain in the lower abdomen on the first day of menstruation. The pain is colicky in nature, coming about every twenty minutes and lasting about five minutes, in fact they are similar to true labor pains. The girl obtains most relief by lying down curled up around a hot water bottle, aspirins may help take the edge off the pain. The pain may be so severe that bed is the only refuge, and pain may continue throughout the night preventing sleep. The pain is easier on the second day and has passed by the third or fourth day. The distribution of pain is in the 'jock strap' area, in fact it covers the area served by the uterine and ovarian nerves.

It would seem that spasmodic dysmenorrhea is due to insufficient oestrogen for maturing and stretching the muscles of the womb.

CONGESTIVE DYSMENORRHEA - Is the presence of heavy, continuous lower abdominal pain during the last seven days of the premenstruum, which increases in severity on the first day of menstruation, and then gradually ceases, together with the end of the other premenstrual symptoms. The congestion was thought to be due to water retention. Congestive dysmenorrhea is another presentation of the pre-menstrual-syndrome. In contrast to spasmodic dysmenorrhea, sufferers of pre-menstrual-syndrome may start with pain at their first menstruation and continue with it throughout their menstrual life, and the symptoms are present whether ovulation occurs or not. The pain is affected by stress, being worse when life in general is in a turmoil and being eased by happy events.

Oestrogen administration increases the severity of pre-menstrual-syndrome, which responds to progesterone. Indeed excess progesterone administered to girls who have not borne children can cause spasmodic dysmenorrhea.

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