Dysmenorrhea: A Gynecological Condition Affecting the Lives Of Nigerian Women 

During a summer coaching class in her first year at Junior secondary school, the then 11-year-old Nini Orise* experienced her first period in Lagos, Southwest Nigeria. 

“My mum had already discussed what a period was, how to use a pad and everything that would happen. I already knew what was coming in theory,” she said. 

Her periods remained painless until she turned 13.  First, there were small amounts of pain, which she thought was expected since they were not debilitating or discomforting. Then, it started to get worse when she got to senior secondary school.

Dysmenorrhea, also known as painful menstruation, is common in women and girls. A study conducted on undergraduate female students in a private Nigerian university revealed that 10 to 15 per cent experience severe menstrual symptoms monthly, disrupting their everyday lives and contributing to feelings of inefficiency, social withdrawal and mental concerns such as loneliness. 

Now 28 and working as a client relationship manager for a local real estate firm, Nini endures debilitating pain every month. “The cramps would start 2-3 days before my period, and the older I get, the worse it becomes. I could even have cramps a week before it starts, alongside other symptoms like bloating and irritability.”

She got an official dysmenorrhea diagnosis in 2017. 

According to Dr Ahmad Yakubu Yunusa, a general practitioner at Epsilon Specialist Hospital, Kaduna,  “A lot of factors such as pelvic inflammatory diseases, urinary tract infections, fibroids, hormonal imbalances and other gynaecological conditions can contribute to this. It becomes an issue when menstrual pain is considered out of the ordinary.”

“It can sometimes present with other irregularities. So, we have to examine the abdomen and run appropriate tests to rule out other conditions,” Yunusa added.

In 2015, Nini had her appendix removed, and immediately after, her period pains became progressively worse. She also started feeling other kinds of pain during a different time in her cycle. Her gynaecologist later explained to her that those were ovulation cramps. 

“When the gynaecologist told me, I almost quarrelled with her in her office because I had never had that in my life. I had to Google it right then to discover it was actually a thing,” Nini said. 

Due to how stressful and emotionally tasking it is to go through the painful ordeal every month, she didn’t want to accept that she now has to deal with more life-altering symptoms. 

“I am already dying from period cramps; it was scary to think I have to deal with ovulation cramps alongside it. She [gyneacologist] explained that some women start dealing with ovulation cramps after a major surgery before the age of 25.” 

Medical misconceptions and dismissal 

The mental strain before the official dysmenorrhea diagnosis was heavy. She struggled to find people who would believe she was in that much pain without dismissing her symptoms or blaming her for them. 

“It affected me mentally because when I started complaining about it, my dad would say it’s because I was taking too much sugar, and it didn’t help that he met a pharmacist who convinced him that was the case.” 

She stopped complaining to him about it. It didn’t help that the first time she went to a hospital, they also assumed her condition was caused by sugar intake. 

To rule out that reason, she started an experiment where she stopped taking sugary items for three months, but that didn’t save her from excruciating cramps. 

“General misconceptions about conditions can lead to this. Since sometimes, patients can claim they have conditions like malaria without mentioning symptoms. It is your duty as a medical practitioner to ask relevant questions to figure out the issue, which sometimes people fail to do. People, including health practitioners, can also have misconceptions that sugar is causing those symptoms,” Dr Yunusa explained. 

The only person who understood Nini’s situation was her mother, who explained that she had also experienced bad period cramps when she was younger. When Nini mentioned this to the gynaecologist, she explained that it could be hereditary. 

“My mum said it reduced drastically after she had children, but I am not sure how that will work for me since I do not intend to have any.”

Dr Yunusa said that family histories can lead to dysmenorrhea in patients. “Sometimes, labour pain may adjust the mindset of women, and sometimes, there are hormonal changes that can cause changes to the female body, and women can find themselves feeling better about certain symptoms.” 

Each time Nini’s period was approaching, she started to feel anxiety alongside bloating and other symptoms, causing her to lose her appetite due to her system being out of sync.

“The cramps are insane. When I was in school, it wasn’t this bad, but when I started working, I would have to leave my desk. When working at a bank, I would go to a corner and curl up in a fetal position for an hour or two. Sometimes, I would forget myself there, and my colleagues would have to come and find me,” she narrated. 

Nowadays, her second and fourth days of menstruation are the worst. She often finds herself lying on the floor of an empty office, her legs propped against the wall, trying to manage the pain.“I also experience butt cramps. When it first started, I thought I was dying. There are months when it’s so bad that I have to take two days off from work, and at the office, they know when I am on my period and avoid stressing me. 

“The gynaecologist I saw was the first one who let me know that cramps can be hereditary. And that even though sugar is not the cause, it can exacerbate the pain. Before I met her, the previous doctor I saw told me it couldn’t be that bad because cramps are normal, and I was probably faking it. They kept giving me Felvin. I took it for three years, which caused me to start having really bad ulcer attacks.”

Nini became conscious of food and drinks that could trigger an ulcer attack. However, only this year did she get a doctor who took her ulcer concerns seriously. 

“For 17 years, nobody ever thought to prescribe pain meds with ulcer meds even when I complained, they would rather give me lesser medications instead that would do nothing for my pain than just treat the ulcer. When this doctor prescribed them, I cried because I felt listened to.” 

The consultation was online, but she felt very seen and validated because he prescribed medications based on what she said, not what he assumed her experience to be. 

Even though she still gets cramps, they are not as bad as they used to be because she started taking ginger shots every day. Research has shown that ginger has anti-inflammatory properties that help alleviate period pains.

“My period lasts for six days, and I used to have period cramps most of the days. Now, I only get them on the second and fourth days and a day before my period. When the pain is worse, I take the prescribed drugs.” 

Now, Nini always insists on advocating for herself when getting any healthcare. 

 Not just a period  

When Kimberly Moses* first got her period during her third year in junior secondary school, she was excited to finally “become a woman” and experience firsthand what her mother told her about. Fortunately, she was home on holiday from the boarding school she attended.

But things took a different turn when she got into senior secondary school. She started experiencing severe cramps.  “I remember when I was on my period then, the whole dormitory would know because of how intense they were.” Kimberly would have to take a day or two off, and as she started growing older, more symptoms started to show up. 

“I feel like every year, our bodies throw in an extra mix of rubbish to confuse us. I don’t know if it’s age, diet or hormones,” she said.“In my early twenties, I would experience vomiting, nausea, weight loss, stool or diarrhoea, and sometimes I would sit on the toilet with a bucket in front of me.” 

There were times when the pain was so bad that she would pass out and wake up hours later. Kimberly would sometimes have to go to hospitals for pain management. 

Premenstrual Syndrome (PMS) is a certain combination of symptoms that appear in women before their periods, which could be physical or emotional. However, the relationship between the female body and periods is far more complex. A study published in Medicine & Science in Sports and Exercise Journal shows an increased risk of injury for female footballers at specific points of their period circle. 

During her school days, she was always scared and anxious that her pain would fall on the day she had an important exam; it happened only once or twice and, on those days, she had to take tramadol despite her mother’s anxieties about the future issues it could cause, like addiction.  

When it first started, she took pain relief medications like Felvin, Diclofenac, Buscopan, and other pain medications. The 30-year-old now works in public health. 

“Especially with work, when I am starting work in a new place, I have to write it down on my medicals so that supervisors will not dismiss it.” There was an instance when a supervisor told her she didn’t need to take those days off because ‘she was not the first woman to menstruate.’ 

“I also make sure to inform human resources,” she added. 

Kimberly did scans, transvaginal ultrasound and other tests to rule out other conditions like endometriosis, PCOS or fibroid. “It didn’t take me long to get a diagnosis, and because my mother also experienced something similar, I figured it was hereditary. My mother always takes care of me when I am going through it because she empathises with me.” 

Her experience with the medical system wasn’t bad because she had worked in healthcare for a long time and always knew the right place to go to get treated well. 

“I don’t take NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) often anymore as the long-term effects are dangerous. Instead, I stick mostly to supplements and diets.  Except on days when the pain is really bad.” 

Kimberly has also cut down on red meat, processed sugars, and soda. She says adding magnesium supplements to her diet also makes a huge difference. 

According to Dr Yunusa, an average hospital can see close to 30-40 dysmenorrhea patients in a year. “Women tend to manage it themselves, and a lot of women living with this condition tend to depend more on analgesics. I have come across some who are addicted to high-end analgesics because of dysmenorrhea and failure to present to hospitals. The turnout may not be as much as you would expect.” 

“I come out of it alive, and there are months that I feel if the pain doesn’t kill me, then nothing else can,” Kimberly told HumAngle. 

Editor’s Note: This story is not intended to provide medical advice. For any concerns or symptoms related to dysmenorrhea or other health issues, please consult a qualified healthcare professional for accurate diagnosis and treatment.