Thursday, July 29, 2010

DYSMENORRHOEA: ONE OF THE CAUSES OF DRUG ABUSE AMONG WOMEN


DYSMENORRHOEA: ONE OF THE CAUSES OF DRUG ABUSE AMONG WOMEN

INTRODUCTION

It will not be out of place for me to say or assume that most Ghanaian female adults and adolescents are at risk of drug abuse. Women by our nature are shy people when it comes to matters concerning our health, and as a result of ignorance or illiteracy, depending on the circumstances, prefer managing our own problems without seeking assistance from people who are knowledgeable. Most of the time, we rely on hear say and what others (friends/peers) have done to resolve their personal health matters, and also try to apply those ideas or suggestions on our own. Indeed, that is very naïve. However, very few of us accept good advice from well-informed people after we’re educated very well on the issues regarding our health. Let’s face it; it’s a fact that most women, who visit the hospital/clinic when they’re sick, represent the category of women whom after several medications on their own did not succeed or had good solution to their problems, and then decided to seek proper medical care at recognized health centres. In fact, aside the ignorance and illiteracy I mentioned earlier, one will be right to attribute this behaviour of women or young girls not going to hospital by themselves, to the way we are brought up in our society i.e. the cultural, religious and traditional believes or influences, etc.

For instance, in the Traditional Dagomba certain, a woman who gives birth in the house is being exalted but the one who delivers at the hospital is regarded as an infidel or in other words, she had the pregnancy outside her marriage and may want to make some confessions which the husband is not supposed to hear, hence the decision to give birth at the hospital. Thus, most Ghanaian women or young girls are drug abusers because; they resort to self-medication whenever they experience a medical condition known as dysmenorrhoea or painful menstruation, which is very common among adolescents and adults.

But the question is, how would you even know that you are suffering from dysmenorrhoea if you don’t visit the hospital or clinic for proper medical examination? Dysmenorrhoea is a common syndrome or disorder associated with women during menstruation.

WHAT IS DYSMENORRHEA?

The syndrome of painful menstruation is referred to as Dysmenorrhoea. Or, it is a painful menstruation with a cramping sensation in the lower abdomen often accompanied by other symptoms such as sweating, tachycardia, headaches, nausea, vomiting, diarrhoea, and tremulousness. These all occur just before or during the menses.

Studies have shown that, dysmenorrhoea is a common gynaecological disorder in women of reproductive age and in Ghana is responsible for a greater proportion of clinic attendance. It is a leading cause of school absenteeism and responsible for the use of painkillers (drugs used in subduing severe pains) in majority of women especially adolescents.


TYPES OF DYSMENORRHOEA

Dysmenorrhoea can be divided into 2 broad categories: primary and secondary. Primary dysmenorrhoea occurs in the absence of pelvic pathology, whereas secondary dysmenorrhoea results from identifiable organic diseases.

Historical attitudes toward menstrual pain were often dismissive. Pain was often attributed to women's emotional or psychological states and misconceptions about sex and sexual behaviors. Research has now established concrete physiologic explanations for dysmenorrhoea, which discredit these prior theories.

Primary dysmenorrhoea affects more than 50% of all women who have a menstrual period. Approximately 5 to 15% of these women have severe pain that interferes with daily activities. Only about one-fourth of all women with dysmenorrhoea have secondary dysmenorrhoea, meaning there is an underlying cause of their symptoms. Dysmenorrhoea usually begins during adolescence.

Primary Dysmenorrhoea: It occurs at the time of menarche (the first appearance of menstrual blood) or shortly after. It is characterised by severe pain which begins before or shortly after the onset of menstruation and continues for 43 to 72 hours.

On examination, pelvic findings are normal. Excessive prostaglandins production is thought to be the cause of dysmenorrhoea. The hormone prostaglandin acts on the uterus by making it contract resulting in the pain.

Psychological factors e.g, anxiety, tension etc can also contribute to dysmenorrhoea. This condition decreases as a lady gets older and resolves after child birth. Approximately 75% of all women complain of primary dysmenorrhoea, but roughly 15% have severe symptoms.

Secondary Dysmenorrhoea:

Secondary dysmenorrhea may present at any time after menarche, but it most commonly arises when a woman is in her 20s or 30s, after years of normal, relatively painless cycles. Elevated prostaglandins may also play a role in secondary dysmenorrhea, but, by definition, concomitant pelvic pathology must also be present. Common causes include endometriosis, leiomyomata (fibroids), adenomyosis, pelvic inflammatory disease, and intrauterine device (IUD) use.

Simply put, primary dysmenorrhoea occurs when the uterus contracts because the blood supply to the endometrium is reduced. This pain occurs only during a menstrual cycle where an egg is released. If the cervical canal is narrow, the pain may be worse as the endometrial tissue passes through the cervix. Pain can also be caused by a uterus that tilts backward instead of forward, low levels of physical activity, and emotional stress. Secondary dysmenorrhea can be caused by the growth of uterine tissue outside the uterus, called endometriosis; non-cancerous growths of muscle and fibrous tissue in the uterus, called fibroid tumors; the non-cancerous growth of the uterine lining in the muscular wall of the uterus, called adenomyosis; inflammation of the fallopian tubes; and the growth of scar tissue, or adhesions, between organs.

The prevalence of dysmenorrhoea is estimated at 25% of women and up to 90% of adolescents. No significant difference exists in prevalence or incidence between races, though the most common causes of dysmenorrhoea differ by age. Although it is not life-threatening, dysmenorrhoea can be debilitating and psychologically strenuous for many women. Some choose to self-medicate at home and never seek medical attention for their pain and this could lead to abuse of drugs (painkillers) such as Ibuprofen, aspirin, paracetamol, etc. Dysmenorrhoea is also responsible for too much absenteeism from work and it is the most common reason for school absence among adolescents.

WHAT DO I DO?

To establish whether you have dysmenorrhoea, you need to go to the hospital for a doctor to take a complete medical history and perform a physical examination, including a pelvic, or internal, examination. The doctor would most likely be your gynaecologist, a doctor who specializes in women's reproductive health. He or she will ask questions about your lifestyle, diet, sexual activity, and any medications you are taking. Fibroid tumors can usually be felt during a pelvic exam, but may need to be confirmed by an ultrasound scan of the abdomen. To make sure any growths are non-cancerous, your doctor may look inside the uterus using a hysteroscope, a small tube with a light that is inserted through the vagina and cervix and into the uterus. He or she may also look for abnormalities in the uterine tissue by removing a tiny sample of tissue from the inside of the uterus, called a biopsy, for examination under a microscope. Endometriosis is usually diagnosed through a combination of biopsy and laparoscopy. With laparoscopy, the doctor makes a small cut in the navel through which he or she inserts a small instrument called a laparoscope. With the laparoscope, the doctor can examine the uterus and other female organs, such as the fallopian tubes, in the pelvic area.

WHAT IS THE TREATMENT?

The treatment of dysmenorrhoea depends on the cause of the problem. In most cases, symptoms are relieved by non-prescribed anti-inflammatory drugs such as ibuprofen, naproxen, and mefanamic acid. If you know you have a history of dysmenorrhoea, your doctor may recommend taking these medications up to two days before your menstrual period begins, and continuing them for one to two days after it begins. It's important to continue to get plenty of rest, follow a good diet, and exercise during your period.

Women with primary dysmenorrhoea that is so severe that it interferes with daily activities, may benefit from a low-dose birth control pill. Because birth control pills prevent an egg from being released each month, the menstrual period is generally lighter and lasts for a shorter time.

Secondary dysmenorrheoa is relieved by treating the cause. For example, fibroid tumors can be shrunk with hormone therapy, or may be surgically removed. Where fibroids are extremely large or cause severe pain, the entire uterus may need to be surgically removed. This procedure is called a hysterectomy, and is also used to treat severe endometriosis. A woman who has had a hysterectomy can no longer conceive a child. Inflammation of the fallopian tubes is treated with antibiotics.

CONCLUSION: As a potential nurse who has ever experienced dysmenorrhoea and know its implications, I thought I should give some form of advice or education to people who do not know or have little knowledge about this health condition. At least, if you are one of those who is fun of taking painkillers anytime you experience dysmenorrhoea or resort to unorthodox treatment, please visit the nearest hospital or clinic next time for proper examination in order to safeguard your future. Wrongful prescription of drugs such as ibuprofen, aspirin, paracetamol, naproxen, and mefanamic acid could jeopardize your health. PLEASE, SPREAD THE WORD AFTER READING THIS ARTICLE.

By: Ms Veronica T. Doohana

Nurse (NSP)

Tamale Teaching Hospital

Northern Region

Ghana, West Africa

Email: verndoo@yahoo.com

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