Dysmenorrhea (Painful menses) পিরিয়ড বা মাসিকের সময়ের ব্যথা

Dysmenorrhea refers to painful menstruation, which is commonly experienced as cramps during a woman’s menstrual cycle. It can range from mild discomfort to severe pain and is typically classified into two types:

1. Primary Dysmenorrhea

This type is not associated with any underlying medical condition and is generally a result of natural hormonal fluctuations. It usually begins within a few years of a woman’s first period and can persist until the late 20s or early 30s. Primary dysmenorrhea is most common in younger women, especially those who have never had children.

• Causes: The pain is due to the release of prostaglandins, which are hormone-like substances that trigger uterine contractions. High levels of prostaglandins can lead to stronger contractions, reducing blood flow to the uterus, and causing pain.
• Symptoms: Cramp-like pain in the lower abdomen that usually starts a day or two before menstruation begins and may last for 2–3 days. The pain can be accompanied by nausea, vomiting, fatigue, diarrhea, or headaches.

2. Secondary Dysmenorrhea

This form of dysmenorrhea is usually caused by an underlying medical condition such as endometriosis, fibroids, pelvic inflammatory disease (PID), or adenomyosis. Unlike primary dysmenorrhea, secondary dysmenorrhea typically begins later in life (often after 30) and tends to be more severe.

• Causes: Conditions like endometriosis (where tissue similar to the uterine lining grows outside the uterus) or fibroids (benign growths in the uterus) can cause chronic pain during menstruation. These conditions may also cause irregular or heavy periods.
• Symptoms: Pain can be more constant, may start earlier in the menstrual cycle, and can be more intense than primary dysmenorrhea. The pain may not be confined to the lower abdomen; it can radiate to the lower back or thighs.

1.    Endometriosis এন্ডোমেট্রিওসিস

Endometriosis is a medical condition in which tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus, causing pain, inflammation, and often affecting fertility. This tissue behaves like normal endometrial tissue: it thickens, breaks down, and bleeds during the menstrual cycle. However, because it’s outside the uterus, it has no way to exit the body, which can lead to inflammation, scar tissue, adhesions, and pain.

Symptoms of Endometriosis

The symptoms of endometriosis can vary greatly between individuals, but common signs include:

1. Pelvic Pain:

1. • The most common symptom of endometriosis is pelvic pain, often associated with menstruation. However, this pain is typically much more severe than normal menstrual cramps.
   • The pain may begin a few days before your period and continue throughout your period or even after your period ends.
   • Pain during or after sex is also a frequent complaint.

2. Heavy Menstrual Bleeding:

1. • You may experience menorrhagia (heavy menstrual bleeding) or bleeding between periods.

3. Pain with Urination or Bowel Movements:

1. • This usually occurs during menstruation. It may feel like a sharp or crampy pain, especially if the endometrial-like tissue is near the bladder or bowel.

4. Infertility:

1. • Endometriosis can contribute to fertility problems, and it is estimated that 30-50% of women with endometriosis may experience infertility.
   • Endometriosis can interfere with the normal function of the ovaries, fallopian tubes, and uterus, making it more difficult for women to conceive.

5. Other Symptoms:

1. • Fatigue, bloating, nausea, diarrhea, constipation, and even headaches can occur, especially during menstruation.

Causes of Endometriosis

The exact cause of endometriosis is not fully understood, but several theories exist:

1. Retrograde Menstruation:

1. • One of the most widely accepted theories is that retrograde menstruation occurs. This is when menstrual blood flows backward through the fallopian tubes into the pelvic cavity, carrying endometrial cells that implant on other pelvic organs.

2. Genetics:

1. • Endometriosis tends to run in families. If a close family member (mother, sister, aunt) has it, you may have a higher risk of developing the condition.

3. Immune System Dysfunction:

1. • Some researchers suggest that an issue with the immune system might be a contributing factor. Normally, the immune system would destroy any displaced endometrial tissue, but in those with endometriosis, it may fail to do so.

4. Embryonic Cell Transformation:

1. • It’s possible that certain embryonic cells in the pelvic cavity transform into endometrial-like cells, though this is less well understood.

5. Hormonal Influence:

1. • Estrogen plays a significant role in the growth of endometrial tissue. High levels of estrogen may encourage the growth of endometriosis lesions.