Part 2 : PERIOD PAIN (DYSMENORRHOEA)

by Dr. Mecherl Lim

MD (MA) Naturopath (ND), Holistic Kinesiology

This is lower abdominal pain that commences just before or during menstrual flow, the first 24 hours being the most painful. 

About 70 percent of women experience some degree of menstrual pain.

WHAT ARE THE SIGNS AND SYMPTOMS?

The pain may be gripping, cramping or a constant ache, and it ranges from mild to severe.  Sometimes it spreads to the back and down the legs.  Period pain may sometimes be accompanied by scanty or heavy flow with clots, headaches, nausea, vomiting, constipation, diarrhoea, sore breasts or dizziness and fainting.

HOW IS IT DIAGNOSED?

A medical diagnosis is required to find out if the pain is menstrual or something else.  Primary dysmenorrhoea is normal menstruation that is accompanied by pain.  Secondary dysmenorrhoea is linked to a cause such as endometriosis, fibroids or polyps.

WHAT CAUSES IT?

Primary dysmenorrhoea is caused when the uterus contracts to eliminate its lining.  Women with period pain probably have high levels of prostaglandins and these compounds over stimulate the uterus.

Secondary dysmenorrhoea has a medical cause such as fibroids (obstructive internal uterine growths) that cause the uterus to contract more powerfully than normal.  Intrauterine contraceptives are also linked to period pain.

HOW ALLOPATHY DOCTORS TREAT IT?

Primary dysmenorrhoea

• Painkilling drugs, such as paracetamol
• Prostaglandin inhibitors, such as ibuprofen
• Oral contraceptives often eliminate period pain

Secondary dysmenorrhoea

The medical treatment depends on the cause and may involve hormones, anti-inflammatory pharmaceuticals or surgery.

PHARMACEUTICAL USE

All drugs have a long list of cautions and adverse effects, as you will see from package inserts or by looking at the MIMs Annual in your library.  Not everyone experiences side effects and you may need to take a strong, quick acting medication for severe symptoms and particularly for pain. If a few over the counter painkillers, such as paracetamol, prevent period or other pain, then that’s the simplest most effective and economical treatment-and it’s unlikely that you will experience side effects from taking, say, two to six tablets a month.

THE HOLISTIC APPROACH

Bed rest with abdominal heat (such as a hot water bottle) is a standard recommendation. This works better if you gently massage about six drops of lavender oil onto your abdomen before applying the heat and lie on your back with a large pillow under your knees.  A combination of eucalyptus and peppermint oil also helps some women and this combination may prevent a headache if you put a few drops on the back of your neck and one drop on the end of your nose.

Herbs : Specific herbs such as cramp bark and wild yam, Chaste tree, Dong Quai, Red Raspberry leaf, False Unicorn, Feverfew, Cinnamon helps to relieve pain and inflammation and reduce the need for pharmaceutical painkillers.

You can also use Dr. Mecherl SHE 18 which is already a combination of the above herbs and you can also see the tea recipe under “Endometriosis” Supplements.

A combination of evening primrose and fish oil works well (and even more so if vitamin E is in the formula), such as Dr Mecherl Femi Vita M or Femi HH.  Neuromous (Magnesium) is sometimes helpful,  I recommend these daily for three months, and if effective relief is relieved, reduce the dose to two weeks, then re-evaluate every few months to find the lowest helpful dose.

This type of schedule works for a number of natural remedies and the aim is to find the lowest helpful dose that works in your case. Subsequently, some women stop taking all remedies, although their pain may recur following illness or major stress.

Other remedies are exercise such as easy yoga may help ease abdominal tension and improve blood flow and therefore reduce pain.  Some women say a glass of wine or a nip of brandy helps!

HOW CAN YOU PREVENT?

Regular exercise throughout each month generally relieves congestion and stress.  Also, you will see under “Premenstrual syndrome (PMS) that a scientific trial showed that a vegetarian diet helps reduce period pain.

GOOD ADVICE

Always do something about pain, because it increases inflammation, prevents sleep, may cause depression and blocks enjoyment.

Next No 52 Issue : CANDIDIASIS
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Dr Ng Peng Wah

Fertility Specialist, Obstetrician and Gynaecologist Royal College of Obstetricians & Gynaecologists in United Kingdom

We sat down with Dr Ng Peng Wah from Genesis IVF and Women’s Specialists to discuss infertility and the taboo surrounding it. Genesis IVF is Penang’s premiere IVF centre aimed at providing effective infertility treatments with world-class facilities to help patients deliver their dreams of having a baby.

我们与起源妇产助育专科中心（GenesisIVF）创立者兼妇科专家伍柄华医生（Dr Ng Peng Wah）讨论不孕症之谜。Genesis IVF 是槟城首屈一指的资深人工试管婴儿（体外受精联合胚胎移植技术）专科医疗中心，旨在提供先进的助孕治疗技术和世界级的硬体设施，协助患者实现生育梦想。

Q: What is infertility and what are the steps someone who has problems conceiving should take?

NPW: Infertility as defined by World Health Organisation (WHO) as the inability to achieve pregnancy after trying for 12months without using contraceptives. If female patients are above the age of 35, they are considered suffering from infertility if they have been trying for 6 months.

The best action to take is also the most direct one – patients should come to see a fertility specialist so that the cause of infertility be identified so that a proper treatment can be attempted.

Q: What are some common causes behind infertility and the treatments to overcome it??

NPW: Infertility causes are varied but it can equally be male or female factors.

A common problem for male infertility is the inability to produce an adequate amount of viable sperm due to endocrinal, physical, chromosomal or other issues.

One of the most common female infertility problems is caused by ovulation. Ovulation problems are often caused by polycystic ovarian syndrome, which is a hormone imbalance problem that causes infertility. Another common ovulation problem is primary ovarian insufficiency (POI), which occurs when a woman’s ovaries stop working properly.

A woman’s age plays an important role in infertility as it has been statistically proven that women over the age of 35 face increased infertility problems. One of the most effective methods is In-Vitro Fertilisation (IVF) in conjunction with other technologies to augment a patient’s pregnancy rates. The beauty of IVF is that it helps overcome many infertility problems including: Blocked tubes, polycystic ovary syndrome, endometriosis, premature ovarian failure as well as low sperm quality.

Q: What are the technologies that can augment a patient’s pregnancy rates?

NPW: We employ techniques such as Intra Cytoplasmic Sperm Injection (ICSI) for patients suffering from low sperm quality to overcome male infertility by manually injecting a sperm into the egg to eliminate the problems of low motility sperm.

Additionally, we have Preimplantation Genetic Screening (PGS) offered to patients to ensure only chromosomally normal embryos are transferred into the mother’s womb. Embryos with abnormal chromosomes usually do not survive pregnancy; even if the pregnancy is successful, the child born with chromosomal abnormalities will be born syndromic such as Down Syndrome, Edwards Syndrome, Patau & Klinefelter. Chromosome defects are one of the most common causes for miscarriage, especially for women over the age of 35.

Q: Before we end do you have any advice for couples facing infertility?

NPW: As a fertility specialist, it is our duty to advocate and educate the public that Infertility is a disease and like any other diseases, couples with infertility should seek out treatment to overcome this disease.

问:何为不孕症？面对不孕我们应该采取什么措施?

NPW : 世界卫生组织 (WHO) 所定义的不孕不育是指在没使用任何避孕药具，备孕12个月后依旧无法怀孕。如果女性患者年龄在 35 岁以上，已经尝试了6个月仍无法怀孕，就会被认为是不孕症。最佳也是最直接的措施——患者应该咨询生育专家，这样除了可确定导致不孕的原因，还可进行适当的治疗。

问:不孕症常见的原因和疗法?

NPW : 不孕的因素多种多样，皆可发生在男性或女性身上。男性不孕常见原因是由于内分泌、生理、染色体等问题而不能生产足够数量的精子。而导致女性不孕的常见原因之一是排卵问题，通常由多囊性卵巢综合征，激素失衡而导致不孕。其它的排卵问题原发性卵巢功能不全 (POI)，这种病例是卵巢停止正常运转。而女性的年龄在不孕因素中有着关键联系，统计数据证明，35岁以上女性面对不孕问题的机率较高。试管婴儿或体外受精 (IVF)是最有效疗法之一，结合其他的技术将可提高患者怀孕率。试管受精的好处在于可协助克服许多不孕问题，包括:输卵管堵塞、多囊卵巢综合征、子宫内膜异位症，卵巢早衰以及精子质量不理想。

问:有什么技术可以提高病人的怀孕率?

NPW : 我们对精子质量不理想的患者采用单精子注射 (ICSI) 等技术，朝卵子中注入精子，解决精子活跃度低下的问题，克服男性不孕。此外，我们还为患者提供移植前基因检测 (PGS)，确保只有染色体正常的囊胚被移植到母亲的子宫中。染色体异常的胚胎通常不能存活；因为即使成功怀孕，染色体异常的孩子也会出现如唐氏综合症，Edwards Syndrome, Patau & Klinefelter 等综合征。染色体缺陷是导致流产的常见原因之一，尤其是35岁以上的女性。

问:在我们结束讨论之前，对面临不孕的夫妇有何建议?

NPW : 作为一名生殖课专家，我们有义务向公众宣导和传达其实不孕症是一种病症，就像其他疾病一样，不育夫妇应该寻求医生进行治疗。