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Ask Dr. Craig!: Excruciating Period Pain

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BellaNaija is pleased to announce a new column for our special readers – ‘Ask Dr. Craig!Dr. Craig is a BellaNaija columnist and one of the doctors who writes for BN Doctors’ Lounge {Get familiar here}. The idea behind ‘Ask Dr. Craig!’ is for BN readers to get quick sharp answers to niggling medical issues that they have. This does not in anyway mean that readers should not go to their doctors. However, sometimes you just need a human face to give answers to those fast, burning medical concerns our readers have.

Send your questions for Dr. Craig to features(at)bellanaija(dot)com stating your full name and where you are writing from. (Your name will never be published) The editor reserves the right to edit submissions for content brevity and clarity. We regret that we cannot provide individual answers to questions sent in and cannot state at which exact date answers would be published.
We hope that people will find help by reading and sharing. We look forward to reading your emails and tweets with questions for Dr. Craig.

***

Dear Dr. Craig

I am 22 years old and I am in my final year at the University of Ibadan.I started my period at the age of 14 and was one of the lucky ones in boarding school who rarely had period pains. However, over the last 3 years I began to have serious menstrual pains, so serious that it feels like I am about to die.

I have tried different remedies and suggestions – avoid sugar a week before my period, drink less water before/during my period, use a hot water bottle etc. But I still feel terrible cramps that leave me unable to do anything during the 3 heaviest days of each period.

It’s gotten so bad that I have been to see several doctors, many of whom just waved me off and said it was normal and that I should toughen up. A few weeks ago during one of the most excruciating episodes I’ve ever had, I went to see a gynaecologist in UCH who has now confirmed that I have a condition called Endometriosis and something that sounded like “cold tummy”. She said I may need to have an operation and I’m really very scared.

I’ve tried to read up on both conditions on Google but I get more confused and scared. Please help!!!

Excruciating-period-pain. Bodija, Ibadan.

***
Dear Excruciating-period-pain,

I’m really sorry to hear about your recent diagnosis and the pain that you have had to endure.

I will try and explain as simply as I can what is going on in your body and hope that you will be able to understand exactly what’s happening to you.

Every part of the female reproductive system is purpose built and designed to perform a specific role in the reproductive process. The ovaries produce eggs for fertilization, the fallopian tubes are the courier service that transports the eggs, the vagina is the collector of the partner’s sperm and the womb or uterus is the incubator. Every part of this well oiled machine works together to ensure that reproduction is carried out in seamless efficiency.

The uterus as we said is the incubator of the reproductive system and its function is to provide a soft and plush cocoon for the fertilized egg to grow. The lining of the womb is made up of a special tissue called the endometrium which acts as a sort of thick blanket where the fertilized egg is nourished and fed.

When the egg is released from the ovaries on the 14th day of a woman’s cycle, the body sends a message to the womb lining (endometrium) to begin to prepare for the possibility that the egg will be fertilized. This message is in form of a spike in the female sex hormone progesterone, which signals to the endometrium to set things in motion. These endometrial cells are especially sensitive to progesterone and over the next few weeks the lining of the womb begins to thicken and fills with blood as it lays out the red carpet and fluffs up the pillows, stocks up on fresh food and fruits and puts up a welcome banner in anticipation of the arrival of a very special guest. If by a certain point the egg is not fertilized, the body instructs the uterus to pull down the welcome banners, roll up the red carpet and put away the blankets. All of these have to be discarded and they find their way out of the body through the vagina. The resulting flow of blood containing clumps of endometrial lining is what we know as menstruation and this happens every month as long as a woman is not pregnant, until she reaches menopause.

In some women, endometrial tissue somehow finds its way outside the womb and into the abdominal or pelvic cavities. These bits of tissue, even though they are no longer in the uterus (womb), still maintain their incubatory function, and so every month when the eggs are being released and the hormonal signal is sent out to prepare for implantation, these patches begin to swell and thicken and fill with blood in preparation, just like they would if they were still in the uterus. When the egg is not fertilised, the endometrium in the womb easily sheds its lining through the vagina, but the patches outside the womb have nowhere to shed their linings as there is no point of exit. As a result these islands of endometrial tissue fill up with blood and form intensely painful sacs of fluid that can often rupture and cause even more pain.
This presence of ‘trapped’ endometrial tissue outside the womb is called Endometriosis

Scientists are not quite sure what exactly causes endometrial tissue to spill outside the uterus, but it is thought that a process called retrograde menstruation accounts for most cases of endometriosis. Retrograde menstruation occurs when menstrual blood and endometrial tissue flow upwards and inward through the fallopian tubes into the pelvic cavity instead of downwards and outwards through the vagina outside the body. There are many theories about what causes retrograde menstruation. Some suggest that activities like prolonged upside down yoga poses or vigorous sexual intercourse during a woman’s period may cause menstrual blood to spill out of the fallopian tubes into the peritoneum. None of these theories have however been proven.

RETROGRADE MENSTURATION

The condition you described as “cold tummy” is actually called Frozen Pelvis.

The fluid filled cysts that form in the pelvic cavity are called ‘chocolate cysts’ because the blood trapped in them can go brown and sticky and looks like chocolate. When these burst, they trigger a severe inflammatory reaction that cause very painful bruises in the inner lining of the lower abdomen or pelvis. These bruises heal by forming scars and these scars can cause the once freely mobile organs in the pelvis to become stuck to the walls and to each other and become fixed and rigid. Sometimes these scars (known as adhesions) can entrap an organ and restrict its blood supply causing even further pain. This rigidity is known as a frozen pelvis and sometimes, as is in your case, the doctor may determine that it would be beneficial to perform an operation to help release the adhesions and improve blood supply to the organs.
Ovary_Endometriotic Cyst1
MULTIPLE CHOCOLATE CYSYTS IN THE OVARY


ABDOMINAL AND PELVIC ADHESIONS
The common symptoms of endometriosis include; Painful periods, painful sex, pain in the lower abdomen and pelvic area and other menstrual symptoms like bleeding in between periods.

Some patients may have difficulty becoming pregnant and this may be due to clumps of endometriosis blocking the passage of the egg from an ovary to the fallopian tube. Sometimes however, the reason for reduced fertility is not clear.

Uncommon symptoms include pain on passing poo (faeces), pain in the lower tummy (abdomen) when you pass urine, and, very rarely, blood in the urine or faeces. Very rarely, patches of endometriosis occur in other sites of the body. This can cause unusual pains in parts of the body that occur at the same time as period pains.

Treatment consists mainly of pain medication and some patients report that paracetamol taken during periods may be all that is needed if symptoms are mild.

Anti-inflammatory painkillers such as ibuprofen, diclofenac, or naproxen, may be better than paracetamol for moderate cases but since these can cause a condition known as NSAID induced gastritis they should only be taken under physician supervision.

In severe cases, a hormone modifiying drug is also given to prevent flare ups.

Please discuss these options with your doctor to determine which in their opinion would be most suitable for you.

Endometriosis is not as uncommon as one may think, and it is reported than 1 in every 10 women has the disease, but because most of these women will have only mild symptoms the condition is often undiagnosed. Endometriosis currently has no known medical cure and so it is important to have a strong support system to hand. A supportive partner or friends and family in addition to internet support groups are very beneficial to making the condition bearable for those with the disease.

Did you know? The former beauty queen and style icon Nike Oshinowo has endometriosis too and is the most prominent Nigerian personality to openly discuss her battle with the condition.

I wish you all the very best and pray that you will get better and be completely symptom free very soon.

***Disclaimer: This column is written for patient education. It is not intended to diagnose or prescribe treatment and does not replace the advice of your physician. It in no means attempts to cover the full medical scope of this condition.

Photo Credit: primehospitalconsultants.com | bbc.co.uk | besthealth.bmj.com | star graphics | ehealthmd.com | webpathology.com | clearpassagephys.netdna-cdn.com

David Olamide Craig is a Pastor, Physician, Sex Educator and Relationship counsellor. Follow him @RevDrCraig or visit www.surulerelove.com

60 Comments

  1. efe

    July 24, 2014 at 9:46 am

    Well spoken Doctor Craig!!!!

  2. Ivy

    July 24, 2014 at 9:49 am

    Cute doctor

    • Teris

      July 24, 2014 at 10:33 am

      ridiculously cute! just that the subject matter is so intense…

  3. Ada

    July 24, 2014 at 9:52 am

    This is serious! I sympathize with the girl. You will be okay soon.

  4. omalichaspeaks.blogspot.com

    July 24, 2014 at 9:54 am

    First of all Dr Craig is such a looker…….fine boy!
    I love the way you took your time to explain endometriosis in the simplest way possible. Well done doc.

  5. ifeoma

    July 24, 2014 at 10:01 am

    Now i understand.Thank you

  6. Bella

    July 24, 2014 at 10:10 am

    [email protected], girl I feel you o

  7. Dollydimples

    July 24, 2014 at 10:12 am

    Tnx Dr. Craig,dat was insightful nd educative..I hope d person involved gets al d care nd help needed to combat d condition..

  8. Tomilola

    July 24, 2014 at 10:15 am

    Dear poster, there are a lot of women around the world with same plight as u therefore stay informed,embrace professional advice, u can follow @ladivamillen on instagram,she is a Tanzanian with the same condition and creating awareness as well as steady information on endometriosis….Above all,pray about it,

  9. mrs chidukane

    July 24, 2014 at 10:16 am

    I find it difficult reading his articles. Maybe the answers are too long and detailed? Or the medical terms makes it seem text-bookey. I don’t know, I just find myself skimming it. Fibroids can also cause painful period

    • pretty

      July 24, 2014 at 10:35 am

      Thank you MY SISTER. Dr. Craig, your replies are too hard to understand. Abeg use simple English and dont explain to us like as if you are in a classroom. Meanwhile, BN please remove this Dr. Craig’s picture,it is a serious distraction. People have serious issues bothering them and the only response we get every time in the comment section is : Is he married? He is such a fine guy. Abeggi.

    • missy J

      July 24, 2014 at 12:44 pm

      LOOOOOOOOOOL sorry girls but as a medical student I think he explained it in the simplest of way like dorosimple. You girls feel that way cause you aren’t medical students I guess. Please its owk for us oo this way cause if he simplifies it any further I feel its going to lose its medical flavour and bleh for us.

    • Tolani

      July 24, 2014 at 12:44 pm

      We want technical. We can get lay man terms from WebMD and google.com

  10. THAT CHICK

    July 24, 2014 at 10:17 am

    IS HE MARRIED YET?

  11. Aibee

    July 24, 2014 at 10:23 am

    Wow! I knew endometriosis had something to do with having endometrial tissue outside the uterus but I’d never given much though to how the whole thing works. To read that those “alien” tissues also get ready to receive a fertilized egg by filling up with blood and laying out the red carpet, blankets and all … I’m just amazed. Now I have an idea of how much pain people with this condition go through. My prayers are you all, and perhaps soon, a cure will be found for this.

    As a follow up question for Dr. Craig, is there any nexus between endometriosis and ectopic pregnancies?

    • missy J

      July 24, 2014 at 12:46 pm

      I was just thinking same thing especially if the egg gets stucked at the fallopian tube.

    • abeeee

      July 24, 2014 at 1:50 pm

      You! #BringBackMyName

    • Person

      July 24, 2014 at 3:47 pm

      haha!!! You are the one that stole the name, kwa! Aibee has been here at least 3 years , this is the first time I’ve seen you here!!! #regularreaders

  12. www.ANEMISTYLE.com

    July 24, 2014 at 10:28 am

    Best explanation about this I’ve read, very insightful. I used to suffer from very bad period pain, could not go to work or even walk sometimes for as long as 4 days. Went for numerous tests/scans, got put on manfanemic, transanemic and even the pill nothing worked so I came off everything. Prayed and I experimented with going vegan, grain free and eating clean. Now its just a slight discomfort if at all there is any pain. Apparently all the hormones in animal products don’t help, this might not work for everyone as we are all different but I know how it feels to be in pain and be desperate for a solution.

  13. www.worldshocker.blogspot.com

    July 24, 2014 at 10:30 am

    JOEL E ANTHONY.: timely revelation, timeless truth

  14. Ruby

    July 24, 2014 at 10:31 am

    I dont use to have menstral cramps. I tease my friends when they cry because of cramps. I didnt know there could be an underlying cause as serious as endometriosis for menstral cramps, Thanks for the new knowledge Dr Craig.
    Permit me to ask, Is it possible to prevent endometriosis? If yes, How do One prevent endometriosis? Your response is anticipated. Thank you.

  15. Ruby

    July 24, 2014 at 10:33 am

    One more question Dr, Are all menstral cramps a result of endometriosis?

  16. CHIKA

    July 24, 2014 at 10:43 am

    Great article!!!! This sheds more light on the dark areas and allays my fears.

  17. Uc

    July 24, 2014 at 10:44 am

    Ha dokitor I thank u ooooooo.I sha know my period knew no cure until i started combining ibrufen and panadol extra every time it comes same with my sister who was always on injection….I dont even want to think of Endo kini?
    It is well with the lady

  18. The Sophia Bello

    July 24, 2014 at 10:47 am

    This is the best explanation I’ve ever gotten for cramps. I get them too, mostly on the first day but nothing Paracetamol/Panadol cannot fix. Thanks Doc!

  19. Baby Yaa

    July 24, 2014 at 10:48 am

    Well said Doctor

  20. wunmi

    July 24, 2014 at 10:51 am

    So sorry to digress but Dr Craig is causing cramps in my heart. He is one fine bruva. Yeah I said it; “runs away”. oops comes back to ask is he by any chance related to Mr Yinka Craig even looks like him sef.

    • Keks

      July 24, 2014 at 3:41 pm

      Yeah. Thats his dad

  21. Kevin

    July 24, 2014 at 10:56 am

    Insightful. Yea, ‘Naproxen’ is one hellova drug. I’ll advise you have a good Dr. follow you up on it’s medication. It works every time. Thank me now!

  22. Jay

    July 24, 2014 at 11:30 am

    Very informative but Dr Craig, pls marry me….0703***16**9. waiting pls.lol

  23. Daisy

    July 24, 2014 at 11:36 am

    Yes Wunmi, Yinka Craig is his Dad.

  24. sum1special

    July 24, 2014 at 11:57 am

    Extremely educative.

  25. yolly

    July 24, 2014 at 12:29 pm

    This is very insightful

  26. Vocalcords

    July 24, 2014 at 12:37 pm

    Any medical explanation for very heavy mentrual flow?(Extremely heavy I mean) It’s been the case since I was 13years old. I have been told it will ease up as I get older but it has not gotten any better. It gets really scary some months and I virtually have to take blood capsules for a long while to keep from passing out..

  27. Vocalcords

    July 24, 2014 at 12:41 pm

    Any medical explanation for very heavy mentrual flow?(Extremely heavy I mean) It’s been the case since I was 13years old. I have been told it will ease up as I get older but it has not gotten any better and I am in my late twenties. It gets really scary some months and I virtually have to take blood capsules for a long while to keep from passing out..

  28. Wonderful

    July 24, 2014 at 1:22 pm

    Very handsome doctor. Hello Dr. David Olamide Craig.

  29. kay

    July 24, 2014 at 1:24 pm

    hi doc,

    pls is there any problem with someone whose period only come for like only two days and there is very little blood.the person hardly uses pad just tissue cause its never heavy.

    the person is a sickle cell patient though.

    is there any medication one can use to regulate the period back to normal to mayb three days and normal flow.

    would appreciate a response and also from blog visitors.

  30. abeeee

    July 24, 2014 at 1:48 pm

    Well heloooooo there dokitor! hehehe

  31. www.toritv.com

    July 24, 2014 at 1:58 pm

    Thanks doc, very educative.

  32. dolapo lawal

    July 24, 2014 at 2:05 pm

    Nice write up, panadol/paracetamol doesnot work for . Only Fexicam , which reduces the flow. i heard It is not good. Pls doc what can i do , the pain is always unbearable if i dont use the said drug . helpppppppppp

  33. NaijaPikin

    July 24, 2014 at 2:43 pm

    Very well detailed explanation, simple enough to follow without down playing the situation.

    People should feel empowered to ask your Doctors questions. You always want to leave the Drs office knowing all questions/uncertainties/fears have been addressed. I guess it might be difficult in naija(esp public hospitals) because of the volume of patients drs have to see. But if you can, don’t be scared or shy, ask.

  34. Sassy

    July 24, 2014 at 3:05 pm

    Thank you Dr Craig, best explanation I have read ever, the diagrams are a very big plus.
    Dear excruciating period pain, I do sympathize with you. I pray you find complete and permanent healing soon.

    I grew up skipping at least a day off school and work every month. It was so bad that I would be writhing and rolling on the floor in agonizing pains, throwing up and doing the number 2 at very short intervals….until I discovered diclofenac (coated).
    Summary, I had to give up diclofenac when I started trying for a baby and the Lord stepped in and for 1omonths before I took in, I didn’t even have to use panadol.

    I don’t know if I ever had endometriosis as I never went for a detailed scan or test but I am living proof that God heals (even when you forget to ask him to). Be strong, the balm of Gilead is still on the throne.

    P.s-Support groups are very essential too.

    • Yinka

      July 24, 2014 at 5:16 pm

      I used to have pain and miss work at least once or twice a month like you described. Everything changed after I had a baby. It was like a miracle, I hardly ever have cramps now.

  35. oj

    July 24, 2014 at 3:12 pm

    men! see tripping for the doctor o

  36. closeya legs

    July 24, 2014 at 3:38 pm

    All these naija women on their ovulation here, Dr Craig is here to advise not to fertilize you all. eesh!

  37. Bode

    July 24, 2014 at 4:04 pm

    I keep telling ppl that Nigerians are educated but not enlightened.You don’t have to be a medical student to understand medical terms.Download medical apps and learn ,so you don’t get misdiagnosed by doctors.
    Dr Yinka keep it up!

    • mrs chidukane

      July 24, 2014 at 11:57 pm

      Guess that applies to you too as a Nigerian.

  38. Adia

    July 24, 2014 at 4:39 pm

    I love how he broke this down. Very detailed and explanatory!
    Thanks Dr. Craig.

  39. ThatYankeebabe

    July 24, 2014 at 4:50 pm

    I actually enjoyed reading this article. Makes a lot of sense.

  40. Fabulicious

    July 24, 2014 at 5:39 pm

    Me I don’t even understand these cramps.I am a mom of 2 but still have cramps like a teenager who just started seeing her flow. It’s just so alarming. There’s no harm

  41. Fabulicious

    July 24, 2014 at 5:40 pm

    There’s no harm in seeing a doctor.Will do.

  42. Labi

    July 24, 2014 at 5:40 pm

    The doctor is fine no be the story.. if you have gone through what Ms Excruciating-period-pain is going through – You might not even notice the doctor.

    I have gone through it – Vomiting, Pooing, urinating, rolling on the floor, – infact when i remove my underwear to use the loo, the breeze that enters my V cases pain.. i have heavy flow for one day, then produce heavy blood clot for the next couple of days ( 3 o 4) I saw a Gyno for almost 5years , took hormonial inbalance treatment, it didnt change,, took strong pain killers like Tramadol. Olfen, Ibrufren.. All the hospital in my areas knows me, clinic at my work place…

    I walked out of about two examination, missed 2 job interview, failed 2 apptitude test because of cramps.. My parents even went local herbal medicine, then i was forced to dough – all na the same then finally i did investigative laparascopy and guess what- the doctor said i am fine.. the small small dots on my endocrine line ( cant remember the technican name he used ) is not enough to call the plan.. so after injection of 120k, surgery of 240k, 3 ultra sound and 1 through my butt hole ( bcos i wsnt sexual active then ) and 5years consultation fees … trust me, i dont think anyone knows the cure to Endometrosis— I have been advised to get pregnant early – in my late 20s and i havent found the one.. ( trusting in God that it wont affect my womb- which my doctor said was intact when i didnt laparascopy surgery).. Wow, really need to start being emotionally available o

    Good news is that, i hardly have that type of cramp now, i dont know if it is has a result of what my doctor did or the drug i am on now– which is the cheapest drug i have ever taken – FELVIN.. .. Even when i travel abroad, i packed my FELVIN… Take 2 days before my period, take morning and night however if i miss one doze – i roll on the floor and get cold – like i am about to die..

    Dear Dr. Craig,

    I am a FELVIN addict when it comes to my period, if i dont take it get “agro”.. is there any side effect of taking FELVIN ?

    • Genny's # 1 Fan!!!!

      July 25, 2014 at 3:15 am

      I can definitely relate! Felvin changed my story as well, I have packs and packs of it…but I keep hearing about it having side effects, and I also noticed that my menstrual flow has reduced drastically (it used to be very heavy before Felvin, especially on the first day) and also the duration has also changed since I started Felvin. I used to have my period for at least 5-6 days solid (very heavy the first 3 days) but now, my period only lasts for about 3/4 days and its really light even on the first day. One time I experimented and didn’t take Felvin when I got my period and the flow was heavier and lasted longer. But the pain was too unbearable, I had to run right back to it the next month. I’m very concerned, I hope these signs wont lead to long term side effects in the future. Dr. Craig, Please feel free to chime in…

  43. ohmine

    July 24, 2014 at 8:49 pm

    I like the way Dr Craig explains things in the simplest way to understand. One can tell he really takes his time to make his readers understand. He doesn’t use big medical terms so I wonder why some people can’t understand the most simple explanation.

  44. toni tone

    July 24, 2014 at 9:49 pm

    He kind of look like Yinka Craig…….

    • Labi

      July 25, 2014 at 7:34 am

      The apple doesnt fall far from the tree…

  45. Dr. Craig

    July 31, 2014 at 10:17 am

    Hello BN readers and thank you for leaving your thoughts and feedback in the comments.

    I noticed that there may be a point of confusion that should be clarified.

    Pain during periods otherwise known as dysmenorrhea is the normal pain a woman feels during the end of her cycle and this is as a result of her womb squeezing and contracting to expell the thick endometrial lining that had been made in anticipation of receiving a baby.
    This is normal and feels like cramping or tightening and should typically reduce in intensity as the womb empties itself.

    Endometriosis is a different kind of pain and is significantly much more distressing than normal period pain and as we have described is as a result of trapped endometrial tissue outside the uterus.

    Not every person with painful periods has endometriosis and this diseases is actually only diagnosed by performing an operation to see the actual tissue located in the abdominal or pelvic cavities.

    Kind regards,
    Dr. Craig

  46. VIKIE

    August 13, 2014 at 11:03 am

    Hi Doc,thumps up,you did a great job with your explanation,i have been having painful period since i started n at a time i take injections every month until a nurse protested to my mum so i started taking Felvin every month cos not even buscopan can help with the pain.Question is what exactly is the short term and long term effect of NSAIDs? esp nw dat m married

  47. blessing

    December 29, 2014 at 1:10 am

    Please Dr Craig, I want to know if taking felvin and buscopan for menstrual cramps has side effect

  48. sum1special

    March 28, 2015 at 11:21 am

    Please Dr Craig answer us oh. I have been taking Felvin too and my period has changed..yes the pain stopped but my flow is lighter and shorter. Please what are the long term side effects of felvin? because i am worried and i keep taking it.

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