Is a painful period a sign of infertility?

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Before we answer the question, let us learn more about menstrual periods and period pain first. For girls, puberty (the transformation of girls or boys into sexual maturity) happens between 10 to 14 years (it happens 2 years later for boys). The first physical sign of puberty is breast development, then the growth of pubic and armpit hair, and finally menstruation (period). The time of the first menstruation is called menarche (the end, at around age 50, is called menopause). There is a growth spurt, reshaping the body to a svelte figure (unless she is fat), a tendency to get acne, and gradual emotional awareness of her sexuality.

The first period is a significant milestone in every woman’s life. It is a confirmation of her biological maturity as a woman, and as one who can bear children and become a mother (in most cases anyway). She can expect to have periods for the next 35 years or more. But with this comes a host of potential problems, the most common of which are painful periods, irregular periods, scanty periods, and prolonged and/or heavy periods. For those hoping to have children, some will face the problem of infertility (the inability to become pregnant).

These period problems can be further worsened by symptoms of premenstrual syndrome (PMS), which are bloating, weight gain, irritability, and fatigue which may start one to two weeks before the period starts. Almost all the changes of puberty and the period problems described above are due to the hormonal changes that occur. Most important are the sex hormones – the estrogens, progesterone (both are female sex hormones), and the androgens (male sex hormones). Other hormones (eg. growth hormone) also play a role. It is common for the periods to start with being scanty and irregular. Then later when the periods become heavier and more regular, many experience period pains (dysmenorrhea). It may take some time for the maturing menstrual cycle to establish itself into a regular healthy rhythm. The perfectly normal cycle is a regular 28-days cycle, with about 7 days of non-painful bleeding (although some discomfort is considered normal).

The normal amount of bleeding should not cause undue tiredness, and should not cause anemia in the long term. In other words, the normal period should not affect a woman’s daily routine. The period pain that comes with or soon after menarche is usually not due to any disease other than the natural functioning of the uterus. Prostaglandins are hormonelike chemicals that are produced in the lining of the uterus. They cause the uterine contractions necessary to expel the menstrual blood. It is believed that the period of pain happens when
there is excess production of prostaglandins.

The pain is often cramping in nature, consistent with the pumping action of the uterine muscle. It may start 1 or 2 days before the blood flows. The pain is maximal when the bleeding is heavy and disappears as the bleeding becomes less. The pain may be severe and may be associated with lower back pain (“referred pain” from the uterus). The worst cases may be associated with nausea, vomiting, and headaches.

Because this is natural with no disease-causing it, it is called “primary” dysmenorrhea. It may lessen or disappear as the girl matures further, and often does not recur after the first pregnancy. During the first pregnancy, the uterus enlarges and becomes very well-nourished. It usually returns to a healthier state than originally after the pregnancy.

However, there are other causes of period pain, in which case the period pain is called “secondary” dysmenorrhea. These include endometriosis (most common), adenomyosis, fibroids (Although heavy bleeding, not pain, is the usual feature), pelvic infections, and adhesions (from chronic infections or previous surgery). Unless treated, secondary dysmenorrhea tends to get worse with time as the underlying cause (disease) gets worse. Hormones also play a role in some of these secondary causes. either as the initiator of the disease, or they make the disease worse. If the period pain is severe, or the period pain occurs for the first time many years after menarche (the first period), or if the pelvic pain is not related to the periods, then you must see a doctor. Since an ultrasound scan is a must in such cases, seeing an alternative health practitioner is not enough. If a problem is found, then the appropriate treatment will be given. Sometimes, additional investigations may be necessary.

Other than period problems and the diseases possibly related to them as mentioned above,
women of reproductive age may also get problems related to abnormal vaginal discharges, abnormal vaginal bleeding, vaginal and pelvic infections, ovarian and vulval cysts, and urinary infections. As they age and go past menopause, other problems become common.

If you are young and have mild period pain, then there is no need to worry. There are simple steps that may help relieve the pain or discomfort – you can try taking a hot bath, put a heating pad or a hot water bottle on your lower abdomen, exercise, or do yoga. If these simple measures fail, you can take a simple pain-killer like paracetamol. If the pain is not relieved, it is best to get checked by a doctor to exclude the secondary causes. If there is none, then the doctor may prescribe a stronger pain-killer (analgesic).

As mentioned above, hormones play a critical role in the development, maturity, and optimal functioning of the female sex organs. While the hormonal environment is genetically programmed, other factors can help maintain and improve general well-being and sexual health. These include a healthy lifestyle (including having sufficient exercise & sleep, stress management, and avoiding alcohol & tobacco), a healthy diet (must include plenty of fruits and veggies), and maintaining a healthy weight & body shape.

It is believed that many problems and diseases of women are due to “hormonal imbalance” – that is, having too much or too little of one or more of the hormones. For menstrual and sexual health, we are concerned with sex hormones, but we must not forget that other hormones also influence sexual health to a certain degree.

Certain herbs have been traditionally used to help the health of women. Examples are kacip fatimah, manjakani, pueraria mirifica, and maca. Some of these may help balance the female sex hormones and maintain healthy periods. We will discover the benefits of these and several other herbs on women’s health in a future article.