Rules so painful that you can not get up ... It happens every month to many women. In Italy, the government is even thinking of special leave "painful rules". The phenomenon, felt in varying degrees according to the women concerned, can also be a sign of more serious gynecological pathologies.

We make the point with Professor Philippe Descamps, gynecologist-obstetrician at CHU d'Angers.

Dysmenorrhea, the medical name of painful menstruation

"The rule of the rules is the brutal hormonal drop related to the stop of the functioning of the corpus luteum, which causes desquamation of the endometrium (or uterine lining) which will be eliminated vaginally", explains d ' Professor Philippe Descamps. "This mucous membrane", he recalls, "proliferated during the first part of the cycle under the action of estrogen and its role is to allow implantation of the fertilized egg in the uterus."

These bases laid - or relearned -, the gynecologist makes his diagnosis as to the painful rules: it is about dysmenorrhea.

What are the causes ?

In this case, during the evacuation of the endometrium, there may be a significant secretion of prostaglandins, responsible for uterine contractions, which, they can be very painful.

Dysmenorrhea - called primary - is often encountered during first menstruation in young girls (about 80% of girls have painful periods). When they (re) appear in the young woman, it is called secondary dysmenorrhea. If its causes are still poorly known, they can sometimes be a sign of a gynecological pathology.

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Painful rules: a symptom of endometriosis

Among them, endometriosis , a disease now better known explains the doctor.

As a reminder, endometriosis, which affects 10 to 15% of women, is caused by the migration of endometrial cells (fragments of uterine mucosa) out of the uterus through the fallopian tubes.

A disease that remains mysterious, as Philippe Descamps explains: "It is still unclear why 85% of women naturally eliminate these fragments of mucosa and others not.The symptomatology may involve, in addition to the painful rules, pain to defecation or urination and dyspareunia (pain during intercourse) ". When endometriosis is suspected, an ultrasound or MRI may confirm the diagnosis.

There is also adenomyosis (an internal form of endometriosis) or the presence of an IUD as causes of dysmenorrhea.

Block the rules to no longer suffer ...

How, then, to relieve these painful rules that become quickly unbearable? "The initial treatment is based on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) which, through their anti-prostaglandin action, reduce pain," says Philippe Descamps.

In the particular case of endometriosis, the first intention is to block the rules. Thus, reflux of uterine lining in the abdomen is avoided.

"A continuous estroprogestative or microprogestative pill is usually enough to calm the pain because the rules disappear, but sometimes a heavier treatment may be necessary or surgery," explains Prof. Descamps.

And to emphasize: "No woman should be condemned to undergo painful rules all her life, do not hesitate to consult her doctor or gynecologist!"

What about a leave "painful rules" in France?

For the expert, the introduction of a leave "painful rules" already applied in some countries, and whose principle seems attractive and fair, raises nevertheless some questions: "It will indeed justify the painful nature of the rules, (more painful than the average? Very painful? and determine the threshold of pain ...) which will require to inform his employer, "he says.

According to the doctor, this could lead some employers to hire more men who by definition can not present this problem and therefore would not be absent several days a month.

There is also the question of intimacy linked to the beginning of a pregnancy: "some women could also see a way to reveal the latter since they will not need this leave once pregnant." An idea to work therefore.