Each month we shed the lining of our uterus and a degree of pain and cramping is natural. But extreme pain –the sort that causes you to miss work or functions – is not. The most common reasons are these eight conditions:
1. High levels of prostaglandins
These are hormone-like substances that trigger the muscle contractions that expel your uterine lining each month. When you have raised levels of prostaglandins, the cramping and pain caused can be raised too.
2. Endometriosis
Sometimes cells from your uterine lining (endometrium) grow in other parts of your body, such as your ovaries, bladder or pelvic floor – and in severe cases, even in your bowel, liver, lungs and brain. This can cause chronic inflammation, blood-filled cysts and internal bleeding, causing great pain. Endometriosis often continuous and can be confused with back pain and irritable bowel syndrome (IBS), says Dr Mogi Lingham, a Benoni gynaecologist.
3. Adenomyosis
This is much like endometriosis, except your uterine lining grows deep into the muscular walls of your uterus. Fortunately it's rare, as it causes not just painful cramping, but pain during sex and for several days afterwards.
4. Fibroids
Non-cancerous tumours are common and mostly have no symptoms, but if they grow large enough, they can increase your menstrual flow and pain, as your uterus contracts more to expel bigger clots.
5. Uterine defects
If your uterus doesn't develop properly before you are born, blockages can cause painful periods and sex, and infertility. With cervical stenosis, for example, your cervix is too small, slowing the menstrual flow and causing pain.
6. Copper IUDs
These can increase menstrual cramps and pain, which usually stop after three to six months.
7. Primary or secondary dysmenorrhea
This is the medical term for when you have pain shortly before and during your periods, but seem otherwise healthy. “Primary dysmenorrhea affects nearly half of all women at some stage, and is usually linked to a problem with your uterus or other pelvic organs,” says Dr Lingham. “If you start off with normal periods and the condition develops later, it's called secondary dysmenorrhea.”
8. Pelvic inflammatory disease (PID)
PID is an infection of the uterus, fallopian tubes or ovaries that can be caused by sexually transmitted infections. These can result in inflammation, scar tissue and adhesions in the pelvis, and when hormones are released during your period, they worsen your inflammation, bleeding and pain.
The good news is that PID responds well to antibiotics, but they can't correct the scarring, which can leave you infertile. Yet another reason to always practise safe sex!
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