I am 31 years old. I have been experiencing terrible menstrual cramps since 2005. Now without taking a pain killer it is impossible for me to even sit. This usually happens on the first day of my periods. How do I get rid of this once and for all? — Sunanda

It’s the classical medical case known by the entity of dysmenorrhea — painful periods on first day of cycle. Lots of time it gets better after marriage or first child birth if the cause would have been cervical stenosis.

The cramps due to dysmenorrhea are caused by uterine contractions. Special chemicals called prostaglandins are released from the lining of uterus and increase the strength of the contractions, during the first couple of days of menstrual cycle (when levels are high). High levels of prostaglandins may cause nausea, diarrhoea and light-headedness. It’s normal to have mild cramps during period, because of uterine contractions.

If the discomfort is not relieved with over-the-counter medications (like ibuprofen) and causes you to miss daily activities, it could mean there is another reason. You may be at risk of menstrual cramps if one is younger than age 30, started puberty early, at age 11 or younger, have heavy bleeding during periods (menorrhagia), have irregular menstrual bleeding (metrorrhagia), have never given birth, have a family history of dysmenorrhea and if one is a smoker.

Painful menstrual periods is classified into two groups, depending on the cause — primary and secondary dysmenorrhea. Primary dysmenorrhea occurs around the time menstrual period first begins in otherwise healthy young women. In most cases, it is not related to a specific problem with the uterus or other pelvic organs. Increased activity of the hormone prostaglandin, produced in the uterus, is thought to play a role in this condition. Secondary dysmenorrhea develops later in women who have had normal periods. It is related to problems in uterus or other pelvic organs, like endometriosis, fibroids, intrauterine device, pelvic inflammatory disease, sexually transmitted disease, stress and anxiety, and premenstrual syndrome.

The doctor would want to do basic investigations like an abdominal ultrasound and in doubtful cases, scans like CT or MRI and rarely a laparoscopy.

The treatment includes:

Anti-inflammatory medication: These are non-steroidal ant-inflammatory (NSAID) medication for one-two days of your period. If your pain is severe, you may want to take an ‘anti–prostaglandins’, they work to stop cramping effects of prostaglandins. They help to relieve discomfort, make flow lighter, and cause uterus to cramp less. Vitamin B1 and magnesium have also been advocated.

Hormonal treatment: Oral contraceptive pills (OCPs), and other hormonal treatments (patch, vaginal hormonal ring, Depo-provera, IUD and hormonal implants) are prescribed because the hormones thin out the uterus’ lining, which lessens blood flow and cramping. They are sometimes prescribed continuously so you don’t get a period.

Heat: A microwavable heating pack or a hot water pad placed on your lower abdomen may help. Soaking in a warm bath also helps. Acupuncture may be recommended to treat dysmenorrhea. Yoga has shown to help lessen menstrual cramps for some girls/women.

Surgery: If menstrual cramps are caused by endometriosis or fibroids, surgery to correct the problem may help reduce symptoms. If fibroids are causing dysmenorrhea, uterine artery embolization (UAE) may help. In this procedure, the blood vessels to uterus are blocked with small particles, stopping blood flow that allows fibroids to grow. Some women can have UAE as an outpatient procedure. Hysterectomy (uterus removal) may be done if other treatments have not worked and if the disease causing dysmenorrhea is severe. This procedure normally is the last resort.

Alternative medicine options include:

• Acupuncture involves inserting extremely thin needles through your skin at strategic points on your body.
• Transcutaneous electrical nerve stimulation (TENS). A TENS device connects to the skin using adhesive patches with electrodes in them. The electrodes deliver a varying level of electric current to stimulate nerves. TENS may work by raising the threshold for pain signals and stimulating the release of endorphins.
• Herbal products, like pycnogenol, fennel or combination products, may provide some relief from cramps.
• Acupressure stimulates certain points on body. This is done with gentle pressure on the skin instead of needles.

I do not have your background in detail like marital status or personal habits or family history but do consult a

gynaecologist with the above data in mind.