The announcement of the text about menstrual pain caused a storm in the editorial office. Some colleagues suggested that this is not a topic at all, because the problem is exaggerated and filmed by hypochondriacs. However, there have also been voices that complaints during menstruation should be treated as a medical condition and should be authorized women for additional dismissal from work.

On this topic, even self-proclaimed feminists do not agree: some believe that femininity that hurts deserves privileges. However, there is a lot of opinion that exposing “women's ailments” is a shot in the knee that harms women in the labor market. Filmed by a heated discussion, I asked an expert, Prof. Marzena Dębska*, a specialist in gynecology and obstetrics, for her opinion.

Eliza Dolecka, zdrav.gazeta.pl: How much can menstruation hurt?

Prof. Marzena Dębska: - It is not easy to answer such a question, because the feeling of pain is an individual matter. In my work, I often meet patients whose state of health makes me suspect that they can really suffer a lot, and they do not complain, do not demand any medication, they can even smile. On the other hand, there are patients who claim that the usual study Ultrasound is very painful. And I'm not talking about the situation when, in fact, something dangerous is happening in the abdomen. It happens that the very application of the ultrasound head to the abdomen already hurts.

Menstrual pains are compared by some women to labor pains. Right?

- This, of course, in most cases is an exaggeration, although the mechanism of pain formation is similar. One of the factors causing complaints is the activity of specific substances secreted within the uterus, the so-called. prostaglandin. They stimulate the myometrium to contract, thereby helping to remove exfoliating endometrium, that is, the mucous membrane of the uterus and the blood that collects. The same prostaglandins during childbirth help the baby to come into the world.

In what way?

- At the time of childbirth, prostaglandins support the process of softening and shortening of the cervix. Together with another hormone, oxytocin, they also cause uterine contractions. Similar cramps, although of a much smaller scale, accompany menstruation. Prostaglandins also increase sensitivity to pain, which can cause, among other things, tenderness of intimate areas. Moreover, prostaglandins also reach other organs, so it is possible that headaches, nausea, vomiting, pain in the lumbosacral spine and even diarrhea are the result of their elevated levels.

Why do some women hurt and others do not know this problem? I've never had painful periods.

- Neither do I. I don't really know what it's like to suffer from physiological processes every month.

Soon someone will accuse us of discussing something we have not experienced.

- Men experience it even less, and it is they who usually discuss women's health and well-being. I think we are more entitled to it, after all. And seriously - I try to listen carefully to my patients, I observe them and I see that some really suffer a lot. This is a common problem. It is believed that pain of varying severity during menstruation is experienced even by every second woman, and in the group of adolescents it is even more common.

‍Why these differences?

- Probably, even anatomical differences matter. This is where the basic principles of plumbing work. Severe pain is often experienced by women with a backbend of the uterus. The path that the removed blood is supposed to travel is “uphill” for them. The muscle has to work harder to get rid of it. The problem also arises when this road is narrow, immature. This is why the so-called primary menstrual pain mainly affects very young women. And hence came the statement, not very liked by women, that “everything will pass after childbirth”, when the cervical canal expands accordingly. This has not been scientifically proven, but in life it often works out. Regardless of the reproductive plans - there is no reason to suffer and wait for the spontaneous disappearance of symptoms, sometimes for many years. The most certain thing is that painful Menstruation will end with the arrival Menopause. No one in their right mind will wait for that anymore.

Primary menstrual pains?

- Yes, we divide menstrual pains into primary and secondary. It's a logical division. We speak of primary when complaints appear at a very young age, most often after a year, two from the onset of menstruation, with the appearance of ovulation. The first cycles are usually anovulatory, in the young woman's body all these annoying hormonal changes, responsible for the formation of the ailment, do not yet fully take place.

We speak of secondary dysmenorrhea when complaints appear (or significantly worsen) in mature women who have not previously had this problem. Usually it is associated with the appearance of various kinds of anatomical changes - endometriosis, polyps, fibroids, but it can also be a symptom of inflammation in Pelvic.

Do you need to worry more about the appearance of pain during menstruation than the primary pain?

- Usually secondary dysmenorrhea has some tangible cause that should be treated, absolutely should not be ignored. However, even if this cause cannot be found, it does not mean that you have to accept the pain. It is necessary to fight him at any age, because he can effectively eliminate a woman from social, professional or school life. I am a supporter of an effective fight against pain, but definitely not menstrual leave. Despite the enormity empathy and the usual “ovarian solidarity”, I believe that serious cooperation with someone whom, unintentionally, for at least a few days each month, eliminates menstruation, must be difficult.

It is generally believed that some women have pain during their period and nothing can be done about it.

- That's not true. We usually deal with pain quickly and permanently - surgically or pharmacologically - depending on the cause. We have a lot of medicines at our disposal. With painkillers, we reduce the production of prostaglandins and hit the pain directly. With antispasmodics, we relieve excessive uterine contractions. With the help of hormones used in general or locally, we can make menstruation shorter and less abundant, because then the whole process associated with them runs more smoothly. The body secretes less prostaglandins, and as a result of unpleasant cramps and other consequences, there are also fewer.

Sometimes, supposedly, even strong painkillers are not enough.

- Indeed, but in such cases, a properly selected contraceptive pill usually solves the problem. Sometimes only an intrauterine device containing hormones helps, very effectively suppressing uterine bleeding. It is a myth that this method of contraception is intended only for women who have already given birth. Even the youngest patients often already know about it and use this method. Worse with their moms, who sometimes have a rather special attitude towards hormones and pain as a problem.

Do they disregard him?

- It's not like that. After all, they often come with their daughter to my office to help the girl. After that, however, it is already worse. Pain medication? No, because it will irritate the stomach or destroy the liver. Birth control pills don't either, because they increase the risk of thrombosis and cancer. IUD - no, because it causes infertility. There are no arguments about the negligible risks associated with the use of modern hormonal preparations, or about the safety and effectiveness of intrauterine systems. I understand this a little, because I am also a mother and I would not want to expose my children to even the slightest danger. However, usually the scale of the life discomfort of these young people is incomparably greater than these risks. Few people know that the likelihood of developing deep vein thrombosis and pulmonary embolism during physiological pregnancy is several times higher than when using a contraceptive pill. Venous thromboembolism is one of the leading causes of death in pregnant women, and it is even more common in the postpartum period. Meanwhile, I have not heard of any mother discouraging her daughter from motherhood because of the risk of thrombosis. We tend to overestimate the risks if “only” the woman's well-being is at stake. This applies to various female problems. It's hard for me to understand.

So hormones and painkillers practically solve the pain problems of all women?

- The exception is those patients who are currently planning a pregnancy. Then, unfortunately, it is often necessary to “strain” yourself, using only analgesics and antispasmodics, because attempts to get pregnant exclude the possibility of using hormonal contraception, which is usually the most effective method of treating painful periods. It is important to start the diagnosis of dysmenorrhea as early as possible, because many times its cause is endometriosis, a disease in which the endometrium spreads outside the uterine cavity - usually within the abdominal cavity, ovaries, fallopian tubes. When endometriosis is already advanced, it manifests itself with pain practically throughout the month, hence few young women suspect this disease when it hurts “only” during their period. This disease still remains a huge challenge, we cannot cure it permanently, but we can inhibit its spread and alleviate the associated ailments. Something else is important. If it is known that it is she who is the cause of the problems, the patient needs to verify her plans for motherhood. He cannot freely postpone them for the distant future. Endometriosis negatively affects fertility. Today, 35 years is often considered the cut-off age for the birth of the first child, but this applies to healthy women. Patients with endometriosis should not postpone motherhood. They should be under the care of a specialist, control the progression of the disease, study the ovarian reserve - then there is a chance that they will manage not to miss the right moment to become pregnant.