Majority of women experience some cramping for one to two days during their period, and this is normal. Cramping is usually strongest in the first one to two days of the period, then settles for the remaining four to five days. This tends to get better as girls get older.
However, some women have period pain that isn’t easily managed and the condition requires them to take time off school or work. Pain to this extent is not normal, and needs to be investigated.
According to gynecologists every month, the uterus prepares itself for pregnancy by growing a thick lining that has rich blood supply, awaiting implanting of an embryo.
When pregnancy does not ensue, the body produces a period, the by-product of the endometrium. During this time the blood vessels open, the lining sheds off the uterine wall, and the uterine muscle contracts to expel the blood and tissue.
During these mild contractions, it’s common for women to feel a lower abdominal cramping sensation as blood products are expelled through the uterine body and out of the cervix before it makes its way out of the vagina and this is called menstruation or periods.
Dr Iba Mayele, a gynecologist& obstetrician operating at Galien Clinic Kimironko says that contractions in periods are triggered by hormone-like compounds produced by the body called prostaglandins, which are the main source of pelvic pain associated with menstruation. Higher levels of prostaglandins have been associated with more severe menstrual cramps.
"If a woman has had years of cramping, she probably has more of sensitivity to prostaglandin. It’s called primary dysmenorrhea, or pain with menstruation, and though it’s painful and should be discussed with your gynecologist, it’s not usually a problem, medically speaking. For some, the pain can also be accompanied by nausea, vomiting, or diarrhea,” he adds.
He notes that if one’s pain is difficult to manage or totally persevere, that’s not normal. If a woman ever experiences cramping regularly outside their period, that’s also not normal. It can be a sign of an underlying condition. Often, it’s paired with heavy bleeding, but not always.
Here are some of the conditions cited to be the cause of a woman’s severe menstruation cramps.
Uterine Fibroids
Usually heavy periods and prolonged bleeding and severe cramping, is a sign of fibroids. What causes them is unclear, but these benign tumors that grow in the walls of the uterus are common, especially in women in their thirties and forties.
"Over 70 percent of women will experience them at some point and women with a family history of fibroids, have an even higher risk, Dr Mayele says.
Endometriosis
On the other hand, Dr.John Muganda, a gynecologist at polycinique la Medicale says painful menstruation can be a sign of endometriosis. This condition happens when endometrial tissue grows where it’s not supposed to, anywhere outside of the uterus. The tissue builds up, sheds, and bleeds, just like it does in your uterus, but without the vaginal escape route period blood is supposed to have.
"Endometriosis can also cause blood filled cysts on the ovaries or lead to the development of scar tissue which can cause fertility problems. These things often cause pelvic pain and excruciating cramping during menstruation,” he argues.
Adenomyosis.
He also reveals that another condition a woman may be experienced behind her period cramps is Adenomyosis. "This condition, which is more common for women in their 30s and 40s, is when the lining of the uterus starts to invade into the muscle of the uterus,” Muganda explains.
"Similar to endometriosis, this tissue still sloughs every month, causing the lining to shed and bleed in the pockets of the muscle. Your uterus contracts and cramps more in response to get rid of the buildup,” he adds.
Miscarriage
Reproductive health experts suggest that when a woman is miscarrying and don’t know it, it can turn out to be a really painful period. However, if the pain is due to a miscarriage, it would only happen in one cycle, not regularly every month.
While some women think that they are supposed to be in a lot of pain during their periods and never speak up, Dr Muganda recommends that they seek medical support earlier as soon as they feel that there is something wrong with their period pain because no matter the cause of the cramping, it can be managed by removing fibroids.
Endometriosis and adenomyosis can be managed with things like hormonal medications, pain medication, and minimally invasive surgery.
Even if it may not due to an underlying condition, simply having horrible pain can be addressed, he stresses. A monthly period is never going to be enjoyable, but it can and should be totally bearable.