Probing into period pain: How prevalent is dysmenorrhea and what causes it?

MANILA, Philippines – Gabriela Representative Arlene Brosas filed on March 22 House Bill No. 7758, which seeks to grant paid menstrual leave of at most two days per month to female employees in both the private and public sectors.

In her explanatory note, Brosas explained that dysmenorrhea or painful menstruation is “poorly treated and ignored” by health professionals and even women themselves, and that women need flexibility and support in managing their reproductive health without facing negative consequences.

Cotabato 3rd District Representative Alana Santos earlier filed a similar bill, House Bill No. 6828. “The real impact of menstruation on women and society is underestimated,” Santos said in the explanatory note. 

“By pursuing this bill, we are not only acknowledging and protecting the women’s health but also, we are raising awareness to avoid stigmatization and ensure that individuals receive the right support,” Santos added.

Dysmenorrhea is defined as the pain felt during menstruation. It manifests through different symptoms, including cramps and pain in the lower abdomen, low back pain, nausea, diarrhea, fatigue, and headaches.

Here are the different types of dysmenorrhea, its causes, and its prevalence:

Primary dysmenorrhea

Primary dysmenorrhea is the pain felt around one to two days before or during menstruation, and lasts from one to three days. It is marked by abdominal cramps, nausea, vomiting, fatigue, and sometimes irritable bowel or diarrhea.

Primary dysmenorrhea is usually caused by strong contraction of the uterus, which interrupts blood flow. This decreases oxygen in the uterus, causing pain.

Primary dysmenorrhea is experienced by 45% to 95% of menstruating women. It usually regresses after a woman gives birth or as they get older.

Secondary dysmenorrhea

Secondary dysmenorrhea is caused by the presence of organic or pathologic entities in the female reproductive system. It also may last longer than three days. It is not associated with other symptoms such as fatigue, nausea, vomiting, or bowel irritability.

The following are some of the conditions that cause secondary dysmenorrhea:

• Endometriosis

Endometriosis is a chronic disease where tissue similar to the uterus lining grows outside the uterus. The disease causes pain and sometimes infertility.

Globally, roughly 10% or 190 million women of reproductive age have endometriosis. In February, the Philippine General Hospital also noted an increase in women experiencing pelvic pain later diagnosed as endometriosis.

There is currently no cure for endometriosis. The pain, however, can be managed with hormonal medications and lifestyle change.

• Adenomyosis

Adenomyosis is a condition that enlarges the uterus. It is caused by tissue in the lining of the uterus growing into the muscular wall of the uterus. It causes heavy menstrual bleeding.

From January 2011 to June 2014, adenomyosis was one of the most common reasons for hysterectomy procedures or the surgical removal of the uterus in the Philippine General Hospital.

• Uterine fibroids

Uterine leiomyomas (fibroids or myomas) are the most common benign or non-spreading tumors that grow in or on the wall of the uterus. Patients with uterine fibroids experience symptoms such as abnormal uterine bleeding, pelvic pressure, and sometimes pain.

According to a study published by the Philippine Journal of Obstetrics and Gynecology, 77% of women have uterine fibroids, 30% to 40% of them symptomatic. These women were mostly in their 30s and 40s. 

Uterine fibroids can be surgically removed.

• PCOS

Polycystic ovary syndrome (PCOS) is caused by a hormonal imbalance that leads to infertility, disordered menstrual cycle, masculinization, and weight gain. It also leads to long-term complications such as diabetes and increased risk of ovarian cancer.

Around 4.5 million Filipinos have PCOS, which makes the condition the major cause of infertility in the Philippines.

Since PCOS cannot be cured, management of the symptoms is the main treatment for the condition through medication and lifestyle changes. – Laurice Angeles/Rappler.com

Laurice Angeles is a Chemistry graduate from the University of the Philippines Diliman and is currently a volunteer under Rappler’s Research unit.