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        There are many ways and means of warding off painful menstruation by those women suffering from it, according to Dr Hema Vijayalakshmi, Sage Surgical Centre, Chennai.

        Elaborating on it, Dr Hema said primary dysmenorrhea is a menstrual pain associated with ovular cycles in the absence of pathologic findings. The pain usually begins within 1-2 years after the menarche (the first occurrence of menstruation in a woman) and may become more severe with time. The frequency of cases increases up to age 20 and then decreases with age and markedly with parity. Fifty to 75 per cent of women are affected at some time and 5-6 per cent have incapacitating pain.

        Primary dysmenorrhea is low, midline, wave-like, cramping pelvic pain often radiating to the back or inner thighs. Cramps may last for one or more days and may be associated with nausea, diarrhoea, headache and flushing. The pelvic examination is normal between menses; examination during menses may produce discomfort, but there are no pathologic findings.

        Treatment - Non-Steroidal Anti-Inflammatory Drugs (NSAID) (Ibuprofen, Ketoprofen, Mefenamic Acid, Naproxen) are generally helpful. Drugs should be started at the onset of bleeding to avoid inadvertent drug use during early pregnancy. Medication should be continued on a regular basis for 2-3 days. Ovolution can be suppressed and dysmenorrhea usually prevented by oral contraceptives.

        Secondary dysmenorrhea is menstrual pain for which an organic cause exists. It usually begins well after menarche, sometimes even as late as the third or fourth decade of life. The history and physical examination commonly suggests endometriosis or pelvic inflammatory disease. Other causes may be submucuous myoma (a benign tumor composed of muscle tissue), IUD use, cervical stenosis with obstruction, or blind uterine horn (rare).

        Diagnosis

        Laparoscopy is often needed to differentiate endometriosis from pelvic inflammatory disease. Submucuous myomas can be detected most reliably by Magnetic Resonance Image (MRI) but also be hysterogram by hysteroscopy, or by passing a sound or curette over the uterine cavity during D &C. Cervical Stenosis may result from induced abortion, creating crampy pain at the time of expected menses with no blood flow; this is easily cured by passing a sound into the uterine cavity after administering a paracervical block.

        On handling the discomfiture, treatment by specific measures, she suggests periodic use of analgesics, including the non-steroidal anti-inflammatory drugs given for primary dysmenorrhea, may be beneficial, and oral contraceptives may give relief, particularly in endometriosis. Danazol and GnRH agonists are effective in the treatment of endometriosis. And by surgical measures, the doctor contends, treatment is undertaken if disability is marked or prolonged, laparoscopy or exploratory laparotomy is usually warranted, Definitive surgery depends on the degree of disability and the findings at operation.