Dr Ayodeji Adeyanju is an obstetrician and gynaecologist with the University College Hospital (UCH), Ibadan, Oyo State. In this interview by OLUWAYINKA AJE, he speaks about painful menstruation, irregular periods and infertility in men and women among other issues. Excerpts.
Why do some women experience severe pain during their menstrual cycle?
Pain during or around menstruation is called dysmenorrhoea. It is not every time one can identify a cause. In adolescent, one will often not find any cause, so that is called Primary or Spasmodic dysmenorrhoea and this will be found in up to about 20% of people with menstrual pain. There are some other cases in which one can identify the cause or likely cause of the pain. This is called secondary or congestive dysmenorrhoea. In this group, the cause is usually because of congestion in the pelvis. Such include fibroid, endometriosis, adenomyosis, pelvic infection etc
Is it true that eating too much sugary things can cause pre-menstrual pain?
Generally, too much of anything is not good, however there is no direct scientific link between painful menses and sugar intake. Nonetheless, for people who have such an experience, they may actually be reacting to a particular substance that they do not know clearly but now considered sugar as the cause. Sugar is glucose joined together by chemical linkages or bonds, if other food sources of sugar do not give them painful menses, then it may not be exactly sugar that is causing the problem.
We also must not forget the effect of belief on human perception. Thinking it was may pre-condition the mind to accept wrong assumption.
What are the factors responsible for irregular periods?
An irregular period is often common in adolescents especially in these first few years after the onset of menstruation. In this people it is largely due to hormonal imbalance. Other causes of irregular menses may include extreme exercise, extreme starvation or extreme weight loss, stress, disease conditions like polycystic ovary disease, severe medical illness, problems with chromosomes, certain drugs can also cause irregular menses. People that are approaching menopause or that egg is finishing in their egg bags called ovaries can also have irregular menses. These are some of the causes.
Is it true that having regular sex or having babies can cure pre-menstrual pain?
Having sex is not a solution to menstrual pain. In women with secondary dysmenorrhoea, the cure is usually directed at the cause. However in people with primary dysmenorrhoea that often have no known cause, it is observed that in most of these women, pregnancy and vaginal delivery would help to relieve the menstrual pain and the explanation for this is that the birth process disrupts the nerves that conduct the pain signals so that after delivery the pain perception is no longer present.
It has been said that irregular period can affect a woman’s chances of having children. What is your take on this?
In the menstrual cycle of a woman, the normal cycle length varies between 21-35 days though many women have cycle length of 28-30 days. In this monthly cycle, a woman has only 24 hours during which she can get pregnant and her fertile period is calculated around the 24hours. Where the menses is irregular, it may be difficult to calculate precisely the period of the cycle that pregnancy is most likely. In this way irregular menses may affect getting pregnant. Also, if the cause of the irregular menses interferes with the process of egg release (ovulation) from the egg bags it may impair conception.
It seems a lot of people are having infertility issue. What do you think is responsible for this?
After two years of marriage, about 10% of couple would still have difficulty in having baby. A couple is described as infertile only after 12 months of marriage with adequate sexual intercourse yet no pregnancy or baby. The problem can be with the man or the woman. For the man, it can be from defective sperm and for the woman, it could be problem with egg release, tubal problem or problem with the womb itself. In some couple looking for baby however, no problem has been found and this is called unexplained infertility. Common causes of problems of a woman’s tube are infection of the pelvis which can follow unsafe abortion, ruptured appendicitis.
What is the cure(s) for infertility?
The cure for infertility is usually directed at the identified cause. However a preventable approach is to avoid behaviours that predispose to having infections of the genital tracts, because the infections in the lower genital tracts can ascend and damage the upper tract like the fallopian tube and this is very important for getting pregnant. Assisted reproductive techniques are now available to help couples achieve pregnancy.
Is it true that women have infertility problem more than men?
Infertility problems are in both male and female. Reported statistics may vary from place to place but generally it is known that if 100 couples with infertility problems are selected at random and evaluated,
About 30 will have male problem while another 30, female problem, another 30, both male and female have problems and in the remaining 10, neither of the couple has any problem.
At what point should delay in having babies be a cause of concern for newlyweds?
A couple is only infertile after 1 year of regular adequate and unprotected intercourse. After one year, they can start to see the doctor, however, where the wife is 35 years old or more, it is advised that they start seeing the doctor after 6months
What advice do you have for couples having delay in children?
Having children is a team work, they should not be blaming of each other. The couple should rather agree together, pray together on this, see the doctor together and follow the doctor’s instructions together. They should not allow societal pressure to destabilise them.
Some people with infertility problem are now doing IVF. What is the success rate of this medical procedure?
Many factors influence the success of IVF. And the recorded success rate varies from one center to another. The age of the woman has a strong influence on the success of the procedure. In the best of centers success rate is as high as 40 per cent has been reported in women from 35 years down ward. While the success rate reduces with increasing maternal age. Many good IVF Centers may report an average of 25-30 per cent success. Implication of this is that 2-4out of 10 will likely succeed.