The Health Blog

Complaints of pain from menstrual cramps were once considered a form of hysteria, not quite as counterfeit a condition as demonic possession, but close enough for disbelievers. The word hysteria is derived from the Greek word hystero, which means uterus. At one time, not long ago, it was common practice to ascribe metaphysical qualities to certain organs of the body, such as the heart representing love, the spleen connoting bad temper, and the uterus suggesting emotional problems.

Freud linked hysteria to sexual repression—a concept still revered by some medical doctors who mistakenly ascribe complaints of pain during a normal biological cycle to a woman’s month)y compulsion to deny her femininity and her sexuality. In fact, women in real pain from menstrual cramps may be assailed by far more than a few days of infirmity a month. They may be suffering from endometriosis and their cries for help arc being answered with outdated theories by physicians who do not understand the severity of their pain.

How do cramps occur and why do some women suffer from them over a lifetime while others never experience a single pang of monthly discomfort?

Physicians once pointed to a tight cervix as the probable and primary cause of menstrual cramps. They felt that this tightness obstructed the natural now of blood out of the body. The treatment for a tight cervix—nearly totally out of use today—was a stretching procedure, a so-called dilation of the cervix. A series of surgical rods of increasing diameters were inserted into the uterus through the cervix. This stretching by larger and larger rods was thought to ease the suffering from severe cramps. Unfortunately, when the stretching procedure was halted, the cervix either healed back to its original size or, as a result of the scar tissue created by the treatment, became even tighter? Clearly, cervical stretching was not the answer for relieving or curing menstrual cramps.

Today we are aware that a tightened cervix may be less a structural problem than a chemical one. Cervical tightening as well as menstrual cramps has been traced definitely to hormone levels, most specifically to a third hormone group involved in menstruation: prostaglandins. There is now an undisputed correlation between menstrual cramping and the presence of high levels of prostaglandins in the female body.

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The various cortisone creams are the most common preparations recommended by the medical profession to be used on the skin. They are known as topical corticosteroids: ‘topical’ because they are applied rather than taken by mouth; ‘corticosteroids’ (sometimes known simply as steroids) because they are derived from the natural hormone produced by the adrenal gland known as adrenal corticosteroids. Their history goes back a quarter of a century to 1952, when Dr Sulzberger, in the United States, first used hydrocortisone. Since then, various molecular changes have been made, often by the addition of fluorine to the basic structure. This has resulted in the increased activity, or the increased efficacy, of the subsequent preparation.

As a result of intense research, many topical corticosteroids have been developed which have remarkable beneficial effects. Their ability to affect various skin conditions depends, as mentioned, on their precise chemical structure. This is termed their potency. Other factors, however, are also relevant to their effectiveness. These include the vehicle or base in which the corticosteroid is carried. For example, ointments appear to be better absorbed than creams. Likewise, creams tend to be more effective than lotions, and so forth.

The age of the patient is also most important, determining, as it does, the absorption capacity of the skin. The relative thinness of the infant’s or young child’s skin, combined with its large surface area in relation to body weight, tends to enhance the preparation’s absorption capacity considerably. Similarly, in the elderly, the thinner, more fragile skin tends to absorb wore freely than does the thicker skin of the middle age-groups.

There is also variation of absorption potential over the body’s skin area. For instance sites which have thinner skin—as do the eyelids—absorb better than areas of thicker skin such as the soles of the feet. The vascularity or blood supply of the area involved is also important in facilitating absorption. Consequently, the scrotum or face absorbs very freely. Opposing skin surfaces such as are found in the armpits or the groin area likewise increase the absorption potential of the preparation used.

The frequency of application is also critical, optimal results being usually achieved with two or perhaps three applications daily. If the preparation is applied too frequently, or for too long a period, there is a slowing down of responsiveness to it. Hence it is wise to change the type of preparation used fairly frequently, as the skin may become accustomed to, and subsequently resistant to, the frequent application of the same corticosteroid.

The topical application of corticosteroids has made possible the relief of much discomfort and disfigurement from chronic skin disease. As with all treatment, there are possible side-effects. These are, however, easily outweighed by the tremendous benefit their judicious use can offer.

These preparations achieve their effect by a strong anti-inflammatory action, whether the cause of the skin disorder be mechanical, chemical, microbiological, or immunological. They also have a strong immunosuppressive action, and consequently diminish local anti-body production. Finally, they have an antimitotic effect on human skin. This accounts for their effect of slowing down the abnormal cell formation in the various scaling skin disorders.

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If every carbon atom has its full complement of hydrogen atoms attached, the fat is saturated, meaning it has as many hydrogen atoms as it can possibly hold. The most commonly occurring saturated fatty adds have 10, 12, 14, 16 or 18 carbon atoms in their chains and are found in meat fat, dairy fat, chocolate, processed fats, coconut and palm kernel oils. Increasingly, the saturated fat in our diet now comes in processed foods and originates from vegetable sources such as palm kernel oil.

Saturated fats are usually solid at room temperature (such as dripping, butter or chocolate). They keep fairly well and this makes them attractive to food manufacturers. They also make crisp biscuits and pastry and crunchy coatings on fried food. Because they’re cheap, have a relatively long shelf life and are useful in processed foods, saturated fats are widely used by food manufacturers. Food labelling does not always indicate whether a fat is saturated or unsaturated.

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I was diagnosed with severe and extensive endometriosis in January 1988.1 had two very large cysts, the size of melons, enveloping both ovaries and extensive adhesions throughout my pelvis. I have had numerous treatments since diagnosis. Following conservative surgery, including two laparotomies for removal of the original cysts and subsequent cysts, division of adhesions, numerous hormonal therapies, including Danazol and Duphaston, with all the side effects, I find I still have active endometriosis and complicating adhesions. Thus, I still have quite disabling pain at various times of the month.

After reading some literature on the use of transcutaneous electrical nerve stimulation (TENS) for dysmenorrhoea, I decided to speak to a physiotherapist friend and ask his opinion on the possibility of pain relief using the system.

He was unable to give me any specific help with regard to its use in endometriosis. However, he could not see any reason why in theory it should not work. I was given the name and address of a physiotherapist who could help and supply a unit for trial.

This physiotherapist was very positive and I hired the unit for a month’s trial, with a view to purchasing the unit. I was very sceptical as to whether this type of pain relief would work — I’m now sorry it took me so long to explore this avenue of pain relief!

From the very first time I used the TENS unit I received some relief — without the horrible feeling of being spaced out, which often occurs with analgesic drugs.

The TENS does not remove the pain completely but it does enable me to manage the pain more easily; it also enables me to lead a fairly active life, without having to pop pills all the time. During the first couple of months of using TENS I required it for the duration of my period but with continued use of the unit I now only need to use it for the first couple of days. It seems that with continued use, the effects of the unit builds up in the individual.

I only have one problem using TENS — a gel must be used on the electrodes to enable the electronic pulses to be conducted to the nerves and this gel can be a little messy. But it’s a small price to pay for such effective pain relief.

The cost of the unit was $230. Initially this might seem expensive but the resulting pain relief has made the cost well worthwhile.

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Because some of the symptoms of endometriosis such as pain and infertility can make the sufferer feel tired, miserable and out of control, women may also experience lethargy, malaise, depression, premenstrual syndrome (PMS), or insomnia.

Is endometriosis a progressive condition-No one really knows what happens to endometriosis if it is left untreated because there have been no comprehensive studies conducted to investigate this problem.

Most gynaecologists presume that endometriosis is usually a progressive condition. In other words, it is a condition which — if left untreated — progressively worsens in extent and severity for as long the woman menstruates.

The rate of progression is thought to vary. It is believed that in most women the rate of progression is fairly slow and that the disease gradually worsens over a period of years. In some women the rate of progression is thought to be so slow that their endometriosis does not progress significantly and so they have mild disease for many years. In contrast, it appears that in a few women the rate of progression is rapid and in some cases it may be so rapid that their endometriosis progresses from mild to severe in a matter of months. Some women seem to have spontaneous periods of remission.

It is impossible to predict the likely rate of progression in any particular woman.

Endometriosis recurs frequently following treatment and approximately 50% of women will have a recurrence of their symptoms, regardless of the type of treatment they undertake.

Unfortunately, some women will have a recurrence within months of their treatment as the rate of recurrence is highest in the first twelve months after treatment. Others will have several years of remission.

Women with severe disease or large endometriomas are more likely to have a recurrence of their endometriosis and their length of remission will usually be shorter.

It is not known if recurrences are due to the presence of residual implants and cysts that were not eradicated by the treatment or whether they are due to the deposition of new implants — or a combination of both these factors. According to one researcher, the higher recurrence rates that are seen in the first year following treatment and in women with severe disease would indicate that recurrences are more likely to be due to the growth of residual implants and cysts.

Occasionally, a recurrence of endometriosis may be experienced following menopause if hormone replacement therapy (HRT) is being used, but usually this recurrence can be controlled by altering the dosages used in the HRT.

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