Kathmandu

Fourteen-year-old Deepti Sharma (name changed) often hopes that she doesn’t get her menstruation during her examinations. She goes through a lot of pain. “When there is pain, I can’t concentrate on my studies. It is even more difficult sitting on the bench during school hours then. It would be easier if it wasn’t like that. But this is a natural process, we have to pass through it,” she shared. She sometimes vomits when her menstruation is painful.

A natural process

Menstruation is a natural process where there is discharge of blood, endometrium tissues, elements of uterine mucous membrane, dead ovum and blood capillaries from vagina at the interval of about a month from puberty until menopause, except during the pregnancy. “Menstruation can be painful in some females, while it may not be painful in others. Vomiting is stimulated by pain in some. This painful menstruation is medically defined as dysmenorrhoea,” informed Dr Umakanta Bhattarai, Consultant Obstetrician and Gynaecologist at Manmohan Teaching Hospital, Swoyambhu and Kantipur General and Dental Hospital, Basundhara.

Primary and secondary

Sharma experiences extreme pain in and areas around the pelvic region. “This pain generally starts when blood is seen and it usually continues for a day. As there is more bleeding the next day, there is not much pain like on the first day,” she shared.

“Menstrual pain usually subsides after 12 hours and in some it can be felt up to 48 hours,” informed the doctor. This painful menses is generally of two types — primary and secondary. In primary dysmenorrhoea, pain starts with an onset of menses and usually ends in 12 hours. However, it can extend up to 48 hours. “This usually occurs in adolescent girls between the age of 12 to 20 years,” shared Dr Bhattarai.

However, in secondary dysmenorrhoea the pain usually occurs three to four days prior to menstruation and can extend up to 48 hours after menses. This usually occurs in married women.

“An underlying difference between these two is that there is an involvement of pelvic pathology in secondary, while there is no involvement of pelvic pathology in primary,” said the doctor. There is pain in and areas around pelvic region even if there is no disease in the uterus and its parts. This is why one doesn’t need to worry, “but one has to be conscious about the causes for painful menstruation”.

Infections and congenital anomaly

Pelvic inflammatory diseases like vaginal infection, uterine fibroid, adenomyosis, (endometrial tissues and glands which lines the uterus, exists within and grows into the muscular wall of the uterus) are some of the causes for painful menstruation. Use of contraceptive devices like Copper T, endometrial polyp — a mass in the inner lining of the uterus, cervical stenosis (narrowing of cervix) are also some of the reasons for painful menstruation in married women. “This is why it is better for married women to visit a gynaecologist if she has painful menstruation.”

Apart from that, if there is congenital anomaly in women, then too menstruation can be painful. In congenital anomaly of uterine organs like uterus, cervix et cetera are differently developed in females. There may be a uterus on one side (unicornuate), or a uterus is partially split (bicornuate), or the uterus is divided by a tissue (septum) (septate uterus), then there is painful menses. As such disorders can’t be seen as the organs lie inside the body, so visiting a gynaecologist is necessary when there is painful menstruation.

Condition in Nepal

People here hesitate to talk about menstruation. However, changes have been seen in urban areas because of education. “Painful menstruation is one of the major problems people come complaining about in our OPDs,” informed Dr Bhattarai. Personal hygiene isn’t maintained and this is why there is infection which in turn results in painful menses. If pelvic inflammatory diseases aren’t treated, then it leads to abscess (occurrence of masses) in ovaries and fallopian tubes. The bursting of such masses can even lead to death.

“To avoid/prevent such infections, one must maintain personal hygiene like washing sexual organs after sexual intercourse, use of clean clothes, sanitary napkins during menstruation,” suggested the doctor. “If there is foul smelling water discharge from the vagina, then visit the doctor immediately.”

When there is infection, there is incomplete treatment in rural areas because of lack of well trained manpower and equipment. However, pain during menses can be treated and medications are available but patients must visit gynaecologists to find the causes for painful menses and get rid of them.