Is Period Pain Normal? Endometriosis, Cysts and Fibroids, with Dr. Rosita Khanum (UCSI Hospital)

Introduction: Meet Dr. Rosita Khanum

Host: Hi everyone, welcome back to Medifly Podcast. Today I'm joined by Dr. Rosita Khanum, an obstetrician and gynaecologist (O&G) based at UCSI. Dr. Rosita, would you like to introduce yourself to our viewers?

Dr. Rosita: Hi, my name is Dr. Rosita. I'm a doctor responsible for delivering babies, and at the same time I make sure that all women are in great health, so that the future babies I'll be delivering are in good health as well. I've been doing deliveries for the past 15 years. I've been performing a lot of surgeries and managing patients with gynaecological concerns. The gynaecological aspect covers problems with your periods, vaginal discharges, and any lesions, bumps, or swellings in the perineum as well.

When Should Period Pain Be Taken Seriously?

Host: A lot of women, myself included, tend to take period cramps for granted. We just accept the pain as part of life. But is there a point where we should actually see an O&G specialist?

Dr. Rosita: This is a very common misconception: that period pains are normal and something we simply have to go through as part of being a woman. Anything that impedes your daily activities, whether at school, at work, or even with household chores, should prompt you to see a doctor and have it treated. We do not want pain to prevent you from functioning as a normal person.

Host: So what is actually considered normal when it comes to cramps? Is it fine as long as we can bear the pain?

Dr. Rosita: Not really. When you are "bearing" something, it means you are forcing yourself to accept it, forcing yourself to do something beyond what you should have to. You don't have to bear with the pain. You're not supposed to have painful periods. If your painful periods are affecting you, that means they need to be treated.

"You don't have to bear with the pain. You're not supposed to have painful periods. But if your painful periods are affecting you, that means it requires immediate attention."

Causes of Painful Periods

Host: What are the possible conditions that make a period so painful? Does it mean something dangerous?

Dr. Rosita: Most of the time it's simply chemical reactions that occur during your period that cause pain. It's not actually a disease. However, there are times when actual diseases, such as endometriosis, are causing the pain. Those cases need to be investigated. Sometimes treatment is required, and very rarely surgery is needed. Period pain as such can happen to anyone, and there are many ways to treat it.

Understanding Endometriosis

Host: What exactly is endometriosis?

Dr. Rosita: Endometriosis is a condition where, instead of bleeding only from the lining of the uterus, you're also bleeding from other parts of the reproductive system as well, including the ovaries, the fallopian tubes, and sometimes even the intestines and the bladder. It can manifest in various ways, but most commonly it presents as period pain that begins even before your period, one to two weeks before it starts.

Host: Is it actually common? I've spoken to a patient with endometriosis who described unbearable pain and even vomiting.

Dr. Rosita: Yes, it's very common. It happens in about one in ten women during their reproductive life. It typically starts before their periods as I mentioned, and then progresses. Some women do find relief from their endometriosis symptoms during pregnancy, so pregnancy is one avenue of relief.

"Endometriosis happens in about one in ten women during their reproductive life."

Host: How serious is endometriosis if left untreated?

Dr. Rosita: Anything painful is serious to me, because if it's painful you're not going to be able to perform your usual activities. But if we're talking about life-threatening situations, endometriosis can sometimes lead to cysts. It can form tumours in your ovaries where blood accumulates inside them. If such a cyst ruptures, there is a risk of bleeding, and that would require emergency surgery to remove it.

Ovarian Cysts: Benign vs. Malignant

Host: Since you mentioned tumours and cysts, I've heard there are two types of cysts, something like an "alive" one and a "non-alive" one?

Dr. Rosita: You're right. Cysts are also very common, as common as endometriosis, occurring in about one in ten women. Most cysts are actually benign, which means they are not cancerous. Malignant means they could be cancerous. Very rarely does a cyst become cancerous; most are benign. Benign cysts usually form as a result of normal changes in the ovary: the eggs can go through changes that cause fluid or blood to accumulate, making them grow larger.

Host: What are the symptoms? Is it just abdominal pain, or are there other signs that you might have a cyst and should get an ultrasound?

Dr. Rosita: Most of the time cysts don't produce any symptoms. We often find them incidentally when investigating something else. Sometimes there is pain, and some women experience irregular menstruation, which can prompt an investigation and lead to a cyst being discovered. When there is pain, what we worry about is an emergency situation: the cyst may have ruptured, started bleeding, or is causing pressure symptoms, perhaps pressing on nerves. Cysts can also twist, which is a real emergency requiring surgery as soon as possible.

Fibroids (Myoma / Leiomyoma)

Host: What about myoma, or fibroids? People in Indonesia commonly call it myoma. Is it the same as a cyst?

Dr. Rosita: It's a bit different. The reproductive system consists of the uterus, the fallopian tubes on either side, and the ovaries. A cyst originates from the ovaries, whereas fibroids, also known as leiomyomas or myomas, grow from the wall of the uterus itself. The uterus is a very muscular structure, and growths or tumours that develop within that muscular wall are what we call fibroids.

They differ from cysts in that fibroids tend to present symptoms earlier. Because a tumour is growing within the muscular structure of the uterus, they usually come to attention with either heavy bleeding or pain during menstruation.

What Is a "Normal" Period?

Host: How do we tell the difference between irregular periods caused by overworking and poor sleep versus something that is genuinely serious?

Dr. Rosita: Periods are very individual. One person may have three days of bleeding and another may have seven, and both can be normal. However:

• More than 10 days of bleeding is not considered normal.
• No period for 6 months is not normal.
• Having two to three periods in a single month is not normal.
• A cycle of 21 to 35 days is normal; anything shorter or longer than that is not.

There's also a saying that you only lose 60 to 80 ml of blood per month. It sounds too little, but that is how it has been quantified.

Having said all that, these are just numbers. What feels abnormal to you is also important. If you feel that something is not right, even just one unusual month, don't hesitate to see your gynaecologist. By doing so, you may trigger an investigation and catch something at a much earlier stage.

"Anything that makes you feel uncomfortable, if you're not sure, you need to go and see your gynaecologist and get it checked."

Bloating, Diet, and the Hormonal Cycle

Host: Is feeling bloated and having a stubborn lower belly something women should be concerned about, or is it just normal body composition?

Dr. Rosita: Bloating and a slightly bigger tummy than usual in the two weeks before your period are actually fairly normal. It's the effect of progesterone released by the ovaries during that window before menstruation begins. There are ways to manage it, primarily through diet. Certain foods cause more bloating than others, and avoiding those foods during that time can help prevent discomfort.

Host: So eating according to your cycle is actually valid?

Dr. Rosita: Yes, it's very surprising. In a year we have 365 days, but in a woman's life it's a 28-day hormonal cycle. From the beginning of your period to the midpoint to the end, changes are taking place every single day because the hormones released throughout the cycle differ. Sometimes one is high, another is low; sometimes they rise together. All of this makes a significant difference to the body.

Host: Is it true that we should eat chocolate during our period?

Dr. Rosita: It's not that we should, but yes, some people do crave chocolate. It's thought to be because of what these hormones do: you tend to become deficient in certain important minerals, such as magnesium. If you are lacking magnesium, you may have stronger cravings for chocolate.

The Most Common Conditions Treated in Clinic

Host: What are the top conditions you most commonly treat in patients who come in with lower abdominal pain?

Dr. Rosita: The most common presentation is pain during periods. We ask several questions to determine the cause. Most of the time we prescribe painkillers. Sometimes hormonal treatments are needed to reduce the chemical effects that contribute to period pain, so that the pain lessens over subsequent cycles. Very rarely we find a growth or cyst requiring surgery.

Debunking Period Myths

Host: I want to debunk some myths. When I was in school I was given a "blood-adding" capsule during my period. Is that actually necessary?

Dr. Rosita: I think what you were given were iron tablets. Iron helps build up your haemoglobin, because heavy periods can cause a drop in your body's iron supply. However, if you have naturally normal periods and you eat a well-balanced, healthy diet, you may not require these supplements.

The other common myth, as we've discussed, is that painful periods are normal. They are not. If you have painful periods, you should see a gynaecologist and get it treated.

Advice for Young Women

Host: If you could give one piece of advice to young women who think period health is not something they need to care about, what would it be?

Dr. Rosita: A lot of women only come to see a doctor much later in life, often approaching their 40s and 50s, when perimenopause causes periods to become irregular and we start to pick up risk factors for certain cancers. But many of these issues could have been prevented from a younger age.

The most important things are:

• Maintain a healthy weight. We use BMI (body mass index) as a guide. If your weight is well-managed, many other things fall into place. Being less overweight means less excess oestrogen in the body, and unopposed oestrogen is one of the main risk factors for certain cancers.
• Exercise and manage stress. This helps regulate the immune system and can reduce period pain.
• Eat enough vegetables and fruits. This provides the vitamins and immune support that help prevent complications later in life.

Host: What specific vitamins should women take?

Dr. Rosita: If you are eating a balanced, healthy diet, you don't need extra vitamins. But if you feel persistently tired, a multivitamin containing a combination of vitamin B complex, folic acid, and iron would be helpful.

"We also pick up a lot of risk factors for cancer during this period of time. But this could have been prevented from a younger age."