Keza, a 32-year-old Kigali-based accountant, is currently hospitalised due to kidney failure caused by long-term use of diclofenac tablets. She began taking this painkiller as a teenager to alleviate menstrual cramps. Even though the painkillers were not prescribed by a doctor, she was able to purchase them in large quantities and keep them on hand as first aid for severe pain, as they are available for purchase at any pharmacy. “Three months ago, I experienced a fever and promptly sought medical attention. Despite completing the prescribed treatment, my condition continued to worsen. I requested the doctors to re-evaluate my condition, and although I was found to be free from malaria, I was still not seeing any improvement,” she shares emotionally. ALSO READ: Menstruation: Effects of painkiller overuse Every month, numerous women and girls endure the discomfort of painful menstrual periods, commonly referred to as menstrual cramps or dysmenorrhea. While some women experience mild pain, others suffer from severe pain that necessitates the use of painkillers for relief. However, medical experts emphasise the potential side effects of long-term use of specific nonsteroidal anti-inflammatory drugs (NSAIDs). This class of drugs, which includes aspirin, ibuprofen, and naproxen, is commonly used to treat inflammation, mild to moderate pain, and fever. However, these drugs can also result in stomach problems, kidney problems, and high blood pressure. In Keza’s case, doctors recommended a comprehensive medical examination to determine if there were any underlying conditions. The results revealed that she was experiencing kidney failure, indicating that her kidneys were not functioning properly. Keza told The New Times she was shocked, as she had not noticed any symptoms of the condition except for minor swelling in her fingers and feet, which she had overlooked. The results indicated that her kidneys were damaged due to the excessive use of diclofenac painkillers, as she failed to consume an adequate amount of water to eliminate the toxins from her body—which called for dialysis. Dialysis is a treatment to clean one’s blood when the kidneys are not able to. “The process isn't only painful, but expensive as well,” Keza said. Consequently, her family is currently fundraising to support her journey to India, South Africa, or Kenya for a kidney transplant. What triggers period cramps? Dr Kenneth Ruzindana, a consultant at the University Teaching Hospital of Kigali (CHUK) says dysmenorrhea is caused by the contraction of the uterine muscles. During the menstrual cycle, the uterus contracts to help shed its lining, which is known as the endometrium. These contractions are triggered by chemical signals called prostaglandins, which are produced in higher amounts just before and during menstruation, he said. “These prostaglandins are responsible for muscle contractions (to help expel blood) from the uterus, in the process, it is this contraction that is felt as cramps,” explained Dr Stephen Rulisa, a chief consultant obstetrics and gynaecology at CHUK, and professor of obstetrics and gynaecology at the University of Rwanda. Ruzindana said that before and during menstruation, the uterine lining releases higher levels of prostaglandins, which are hormone-like substances. Prostaglandins serve various functions in the body, including promoting inflammation and muscle contractions. Increased levels of prostaglandins cause the muscles of the uterus to contract more forcefully than usual. These contractions help to shed the uterine lining that has built up during the menstrual cycle, Ruzindana explained. The contractions can lead to pain and discomfort, commonly referred to as period cramps. “The strong contractions of the uterine muscles can temporarily reduce blood flow to the uterus, which can further contribute to pain and discomfort. Reduced blood flow can lead to oxygen deprivation in the muscle tissues, eliciting pain sensations,” he said. Ruzindana went on to say that the severity of period cramps can vary from person to person, stressing that some individuals experience mild discomfort, while others may have more intense and debilitating pain. He explained that factors that can influence the intensity of period cramps include hormonal fluctuations, genetics, overall health, and the presence of certain medical conditions. “While some degree of discomfort during menstruation is normal, excessive pain that interferes with daily activities or is accompanied by other symptoms like heavy bleeding, nausea, vomiting, or fever should be evaluated by a healthcare professional.” Ruzindana added that doctors can help diagnose any underlying conditions and recommend appropriate treatment to manage period cramps. At what point are painkillers risky? Rulisa said painkillers are acceptable for use, but like any medication, excessive use or overdose can result in side effects. For instance, certain painkillers, such as aspirin, can inhibit coagulation or clotting, resulting in increased bleeding. Ruzindana explained that overusing painkillers, especially non-prescribed, during menstruation can have several potential side effects and risks. He noted that it’s important to use painkillers responsibly and follow the recommended dosage and guidelines provided by a healthcare professional. “Non-prescription painkillers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can irritate the stomach lining and increase the risk of gastrointestinal issues such as stomach ulcers, bleeding, and gastritis,” Ruzindana explained. In addition to this, excessive use of painkillers can strain the kidneys, especially if taken for extended periods or in high doses. This can potentially lead to kidney damage or worsen pre-existing kidney conditions, he warned. According to Ruzindana, some painkillers like paracetamol can cause liver damage if taken excessively or combined with alcohol. Overdosing on paracetamol is a serious concern and can lead to acute liver failure. “Regular overuse of painkillers can lead to tolerance, where you need higher doses to achieve the same effect, and even dependence, where your body becomes reliant on the medication,” he clarified. He emphasised that excessive use of painkillers can conceal any underlying medical conditions that may be the root cause of menstrual pain. Therefore, it is important to address the root cause of the pain instead of solely relying on pain relief. Curbing menstrual pain To manage period pain effectively and safely, it is important to consult a healthcare professional. If period pain is severe or consistently interferes with daily life, they can provide guidance on appropriate pain relief methods and investigate any underlying conditions, Ruzindana said. ALSO READ: Natural ways to reduce menstrual cramp pain “Important to note, follow dosage instructions if you use over-the-counter painkillers, strictly follow the recommended dosage instructions. Do not exceed the stated dose or duration of use,” he warned. Ruzindana explained that there are various alternative methods for managing menstrual pain, such as heat therapy, relaxation techniques, exercise, dietary changes, and herbal remedies. ALSO READ: How to handle painful menstrual periods He recommends discussing these options with a healthcare provider, and if over-the-counter painkillers are not providing sufficient relief, your doctor might recommend prescription medications or other treatments. Alternatively, Rulisa advises placing a warm cloth on the stomach, drinking warm water, and focusing on gentle exercises. Dr Shakhnoza Abdukhalilova, a gynaecologist at Deva Medical Centre in Nyarutarama, explained that consuming food rich in Vitamin E can reduce pain. “This is because of its antioxidant properties; vitamin E reduces phospholipid peroxidation and inhibits the release of arachidonic acid and its conversion to prostaglandins. Therefore, it can play a significant role in relieving the severity of dysmenorrhea.” She said that zinc has been found to relieve menstrual cramps and swelling, and omega-3 fatty acids may be effective in easing menstrual pain due to their anti-inflammatory properties. Trials conducted in 2012 and 2018 suggested that omega-3 fatty acids also helped to reduce the usage of ibuprofen which is commonly used as a painkiller. Dr Abdukhalilova recommends taking herbal tea such as camomile, and turmeric, keeping warm, and massaging the stomach gently with essential oils as they lessen period pain and discomfort.