Period pain is uncomfortable and unpleasant, and no woman should have to ‘grin and bear it’. While period pain is common, it isn’t normal. While symptoms vary considerable between women, the pain is usually described as a heavy, dull ache (congestive dysmenorrhoea) or spasmodic, cramping pain (spasmodic dysmenorrhoea). The pain may start before menstruation begins however most commonly the pain will start once the bleeding has commenced and intensifies as the flow becomes heavier and clots are passed. Vomiting or diarrhoea may accompany the pain. Many women can reduce the severity of their pain simply by changing their diet and exercising, however a combination of herbs, nutritional supplements and structural realignment and in some cases acupuncture can be very successful in treating the pain.

It is very important to point out to your practitioner if:

• The pain has changed in character or is present for the first time
• Pain is aggravated by pressure, bowel motions or sexual activity
• Fever or discharge accompanies pain
• Pain is on one side only, or radiating
• Usual pain control measures are no longer useful
• Pain worsens towards the end of the period

However, other underlying causes may also be to blame:

1- Pelvic inflammatory disease
PID is caused by infection and symptoms include abnormal bleeding and heavy menstruation. Other common symptoms include fever, fatigue and pelvic pain. It is interesting to note here that for an infection to establish itself the organ must have already been compromised. Maybe the nerve or blood supply to that area is inadequate or the drainage incomplete. While you may need some medical inetrvention it is importnat that the actual underlying cause of the infection is removed to prevent it reoccurring.

2- Intra-Uterine Device (IUD)
The IUD may cause heavy and painful periods and mid-cycle bleeding. A dislodged IUD or infection can cause severe pain and/or bleeding and needs immediate attention by your doctor.

3- Endometriosis and Adenomyosis
Endometriosis is caused by endometrial tissue growing in an incorrect place, such as the ovaries, tubes, outer wall of uterus, bladder or bowel. It is not well understood by this occurs, however it is believed to be a condition of oestrogen excess, as oestrogen is responsible for the development of endometrial tissue. It had also been suggested by some researchers that there is a parasite which moves the endometrium (lining of the uterus) to areas outside the uterus. Since oestrogen signals the body the regrow the endometrium each month the endometrium which has been moved keeps growing. Immune dysfunction and ‘backward’ or retrograde flow is another possible cause. Endometriosis can affect fertility as it can cause adhesions in the fallopian tubes.

Adenomyosis is caused by the growth of endometrial tissue in the uterine muscle. Symptoms are many and varied, and can include heavy and congestive or dull and dragging pain while menstruating or before ovulation. Often the pain is worse before the period or increases in severity towards last days of bleeding. Pelvic discomfort, painful sex and abnormal bleeding patterns can occur. Longer cycles are possible, however a shorter cycle with a heavy period is more common. The flow itself may be thick and tarry at the start and spotting and mid-cycle bleeding are possible.

4- Pelvic congestion syndrome
The most frequent symptoms include a dragging or heavy lower abdominal pain at any time of the period, congestive period pain, low backache and pain during sex. The lower abdominal pain often becomes worse at the end of the day as blood pools in the veins. The cause of this condition is in most cases corrected by osteopathic treatment or other manual techniques which restore the body's ability to have free blood flow to and from the pelvis as it is associated with engorged pelvic blood vessels. This condition is most common after the age of 35 and after a woman has had a number of pregnancies.

Tests that may be required

It is possible to effectively treat period pain in our clinic without most tests. However if your practitioner thinks it necessary they will refer you to a another member of the clinic or in some cases to a medical doctor for one of the following tests. It is important to us that you only have the tests that are really necessary to assist in your treatment.

1- Pelvic examination
This involves viewing the cervix with a speculum to see whether it is normal and healthy, and examining the pelvic organs by inserting a gloved hand into the vagina to feel the size, state and position of the organs. This can be used to show if the uterus is enlarged and tender due to pelvic congestion syndrome.
2- Laparoscopy
This involves inserting a thin-pencil like instrument through various incisions in the abdomen through which the organs can be viewed. This procedure requires a general anesthetic. Endometriosis, adenomyosis, adhesions, ovarian cysts and fibroids can all be detected using this method. It can also show if the pelvis is enlarged and tender or engorged pelvic blood vessels due to pelvic congestion syndrome. This technique is used in conventional medicine as a treatment for endometriosis.
3- Pap smear
This can be used to rule out infection as the cause of heavy menstruation. Cells are gently scraped from the surface of the cervix and sent to a pathology lab for testing.
4 – Ultrasound
This uses a type of imaging to show the contents of the pelvic cavity. The image may be taken abdominally or vaginally. It is most appropriate to diagnose adenomyosis or ovarian cysts.