What is period pain?
Period pains are cramping abdominal pains that occur just before or during a woman’s monthly period. This type of pain can affect around 80% of women at some point in their lives. The medical term is dysmenorrhea – and primary dysmenorrhoea is the common type. It often occurs in teenagers and women in their 20's. Secondary dysmenorrhoea is less common. This usually begins when women are between 30 and 45 years of age and may be associated with an underlying problem.

Symptoms of painful periods
Cramping pains in the lower abdomen are the most common symptom but they are sometimes accompanied by lower back pain, nausea or headaches and even vomiting, diarrhoea, constipation or feeling faint.

The pain can last up to two to three days and tends to happen in the first few days of the period, coinciding with the time of heaviest blood flow but period pains do not cause any damage to the uterus (womb).

What causes period pain?
The cause is unclear but chemicals produced in the lining of the womb – prostaglandins – may be responsible. Prostaglandins help the womb to contract and shed its lining during a period. In women with period pain prostaglandins may build up excessively, or the womb may be extra sensitive to the prostaglandins.

Treatment
Although you can’t prevent period pains, there are several options to help relieve them.

• A warm bath can be soothing and you may find it helpful to press a hot water bottle – not too hot – against your abdomen, and your lower back if you have pain there. During the day, self-heating packs warmed in a microwave may be a convenient alternative.
• Moderate physical exercise can also be helpful for relieving pain, and may even help prevent period pain.
• Analgesics such as paracetamol or anti-inflammatory drugs like ibuprofen can also provide relief. Anti-inflammatories work by decreasing the level of prostaglandins. These drugs are not suitable for everyone – for example, people with asthma or indigestion problems may not be able to take them – so ask your pharmacist about what would be best for you.
• TENS (transcutaneous electronic nerve stimulation) devices – where small electrodes are placed on the abdomen to stimulate the nerve in the pelvic area – may be helpful. Your pharmacist can also tell you more about this.

When to see your doctor
Up to 15% of women have period pains severe enough to interfere with their daily activities. You may need to see your doctor if your symptoms are particularly severe, change or if you notice any other symptoms associated with your periods.


What not to do
Don’t delay taking medicines until the pain gets severe. Starting to take medicines when you first need them is usually far more effective than leaving it too late. Your pharmacist is an expert on medicines and how to use them, so although you can help and mostly treat yourself, for something like period pain that will need regular repeated treatment, it’s worth a quick consultation with your pharmacist so that you get things right.

IBS
Irritable bowel syndrome or IBS is a common digestive disorder, and is thought to affect roughly one in five people. It is more likely to affect people between the ages of 20 and 30 and is more common in women. People experience IBS differently and symptoms can fluctuate from being mild to severe at other times. It is a condition that can be controlled, but it is important to get a medical diagnosis to rule out other possible causes of the symptoms.

Once diagnosed, there are a number of effective options available which can help to minimise the impact of IBS on your life. For most people, the severity of IBS will decrease over time.

What are the symptoms?
People with IBS can experience one or more of a range of symptoms but the syndrome can be broadly divided into four main types depending on the predominant symptom – abdominal pain, diarrhoea, constipation or diarrhoea alternating with constipation. Other symptoms can include excess wind, nausea, and indigestion.

What causes IBS?
The exact cause is unknown but it is thought that stronger than normal muscle contractions in the bowel wall have a role to play. These contractions may be worse if you are stressed or after eating food especially if you are intolerant to those foods. IBS can also develop after a gastro-intestinal infection.

How is it treated?
Unfortunately there is no cure for IBS but a combination of lifestyle adjustments and, if required, medication and advice from your pharmacist may help

Changes to diet are an important way to help prevent and reduce symptoms of IBS and in general a healthy balanced diet with fruit, vegetables and plenty of water can be helpful. If diarrhoea is the main problem, then irritant foods such as alcohol, spices, tea, coffee and also the artificial sweetener sorbitol should be avoided. For constipation it is important to have a diet with plenty of fibre which can be found in fruits and vegetables. Exercising regularly will also help reduce stress and help maintain bowel movements. If possible, paying attention to which foods are triggering the IBS and avoiding them will also lead to improvements.

If medicines are required and IBS has already been diagnosed by a doctor then your pharmacist can help you with choosing the best ones for you. For diarrhoea, loperamide or diphenoxylate can provide relief in the short term but should not be used regularly.

In patients with constipation to which a change in diet has not helped, then bulk-forming laxatives such as Fybogel can help, other types of laxatives such as lactulose may also be useful but patients need to be wary of using stimulant laxatives such as senna which can cause rebound constipation if used for too long. If pain, cramping or wind are problems then antispasmodic medicines, such as mebeverine and peppermint oil, may help. If lifestyle changes and medicine treatments do not give you sufficient relief, talk to your pharmacist. He or she will refer you to your doctor if necessary.

Mythbuster
Many people believe that IBS can lead to bowel cancer but there is no link between IBS and bowel cancer.

How your pharmacist can help put you in control of your asthma
If you have got asthma, you’re not alone. There are around 5.2 million asthma sufferers in the UK. Help is available from a variety of sources including your local pharmacy.

Who can answer questions about asthma medicines?
Pharmacists can answer any questions you may have about your asthma medicines and can also check to see if you are able to use your inhaler easily. If you find it difficult to use your inhaler, or feel that it is not controlling your symptoms, talk to your pharmacist about changing to something that is easier for you to use.

I’ve got a blue and a brown inhaler – what’s the difference?
The blue “reliever” inhaler quickly relaxes the muscles surrounding the narrowed airways. This allows the airways to open wider, making it easier to breathe again. The brown “preventer” inhaler controls the swelling and inflammation in the airways, stopping them from being so sensitive and reducing the risk of severe attacks.

Why do I get through my inhalers more quickly sometimes?
If you seem to run out medicines before your next prescription it could be because you’re using your blue “reliever” inhaler more often. Sometimes that can be a sign that your asthma isn’t very well controlled. Ask your pharmacist for advice if you have to use more “puffs” of the blue inhaler than usual.

Is there an easier way to get my repeat medication?
If it’s hard to organise collecting your regular prescription from the doctor there is now a new repeat dispensing NHS pharmacy service that might help. With repeat dispensing you do not need to visit the GP surgery every time you need further supplies of medicines. This new service, available to patients in England, means that you can get your repeat medication direct from the pharmacy for a number of months. If this sounds like a service that would help you then talk to your pharmacist about whether this is available in your area.

Will smoking make my asthma worse?
If you’re a smoker and have asthma you’ve got a good incentive to quit. Smoking worsens asthma and counteracts asthma medication by worsening the inflammation of the airways that the medicine tries to ease. However mild or severe your asthma is, stopping smoking can reduce your symptoms, making asthma easier to manage. So when you are ready to stop your pharmacist can offer you advice and support in confidence if you wish.

How do I know if my medicines are working?
Finding yourself short of breath during the day or if your asthma wakes you up at night it could mean your asthma isn’t as well controlled as it could be. Next time you’re in your local pharmacy take a minute to talk to your pharmacist and find out if you’re getting the most from your medicines.

What is emergency contraception?
The ‘morning after’, or emergency contraceptive pill, is a form of birth control used to prevent pregnancy after unprotected sex. It can be used in many situations, for example if a condom or diaphragm becomes dislodged or if you forget your usual method of contraception. The morning after tablet can be taken up to 72 hours after unprotected sex however it is more effective the earlier it is taken. Taking the ‘morning after’ tablet within 24 hours of unprotected sex prevents approximately 19 out of 20 pregnancies.

How does it work?
The tablet will prevent an egg being released (ovulation), delay it until a safe time or prevent implantation of an egg that has already been fertilised.

How effective is it?
It is very effective but the longer the delay after sex has taken place the less effective it might be. It is about 95 per centeffective if taken within 24 hours, but it is not known how effective it will be if taken after 72 hours.

Is it safe for me?
Emergency contraceptive tablets have no long-term or serious side effects, and emergency contraception is safe for almost every woman to use. However, if you are taking other medicines or complementary medicines such as St John’s Wort, you do need to tell the pharmacist – you may need some advice tailored to your circumstances. If the tablet does not work or you are already pregnant, there is no evidence to suggest that it will harm your baby.

Are there side effects?
You might find yourself feeling queasy and occasionally women vomit after taking emergency contraceptive tablets. You might also get a headache, feel tired or dizzy, have some lower abdominal pain, or find your breasts are more tender than usual. If you do feel this way, it should stop within a day or two. Some women also experience some unexpected bleeding – this is not dangerous and should clear up by the time you have your next period. The tablets might also cause your next period to come early or late.

If you vomit within two hours of taking the tablet you should ask your pharmacist for advice. They may recommend you take a repeat dose, and that you take a medicine to stop you vomiting again.

How can I buy the tablet from a pharmacist?
If you are 16 or over, you can ask the pharmacist for emergency contraception. Just ask for a word in private with the pharmacist. Many pharmacies have a consultation area where the pharmacist can talk to you in private. The pharmacist will need to ask you some questions to make sure that the morning after tablet is suitable for you. It is also available on prescription from your doctor, hospital or local contraception or sexual health clinic.

Myth

Some people say you can only take emergency tablets once. That's not true, although it isn’t suitable for use on a regular basis as it’s not as effective as other methods of contraception, and doesn’t protect you against sexually transmitted infections.

If you are worried about this or any other side effects ask your pharmacist – you’ll be getting good advice.

What are STIs?
Sexually transmitted infections (STIs) include chlamydia, syphilis, and gonorrhoea – there are about 25 in all. They can be passed on through intimate contact, for example during sexual intercourse or through genital contact with an infected partner.

What causes them?
Most STIs are caused by bacteria (chlamydia or gonorrhoea) and viruses (HIV, genital herpes).

Symptoms
Symptoms can include itching, swelling or redness around the vagina or penis, unusual discharge from the vagina or penis, pain during sex or when passing urine or pains in the lower abdomen. Some infections, such as chlamydia, may have no symptoms or symptoms may subside, fooling you into thinking that an infection has cleared up. Unfortunately, this may not be the case and if you do not receive treatment the infection may remain and cause long term complications for your health as well as the risk that you may pass the infection on to someone else.

How can I tell if I have an STI?
You can find helpful leaflets or get confidential advice at your local pharmacy. If you think you may have an infection, or have had unprotected sex, you can be tested and have advice from your GP, your local family planning clinic or your local GUM clinic. You don’t need a GP referral to make an appointment at a GUM clinic and you can find your nearest one from www.condomessentialwear.co.uk/get-help or call the NHS free and confidential sexual health helpline: 0800 567 123. Alternatively, you can contact NHS Direct on 0845 4647.

Tests may include taking swabs, blood or urine samples but the recent development of newer tests means that some infections, including chlamydia, can be detected from a urine test. These are sent to a laboratory for testing and the results are usually available within a week. Chlamydia testing using urine samples is also available at some pharmacies.

Treatment
Most sexually transmitted diseases (STIs) can be treated with a short course of antibiotics. These include chlamydia, gonorrhoea, syphilis and urinary tract infections.

It is important to treat STIs, as untreated infections can lead to serious complications, such as pelvic inflammatory disease, ectopic pregnancy or infertility. Men can also experience inflammation and discomfort of the testicles or prostate gland.

Prevention
Simple measures can reduce the risk of catching STIs – such as using a condom. This can help prevent the spread of HIV and reduce the risk of most other STIs for both men and women. Once diagnosed with an STI, If you have a positive diagnosis of an STI, it is important that your current and past sexual partners are notified and treated, in order to reduce the risk of spreading and re-infection and it is wise to wait until you have the ‘all clear’ before having sexual intercourse again..

Did you know?
Between 1996 and 2005 diagnoses of STIs increased by 59% – diagnoses of genital chlamydia rose by 206%, gonorrhoea by 55% and syphilis by a massive 1,949%.
Chlamydia is implicated in more than 50% of cases of pelvic inflammatory disease, which can lead to ectopic pregnancy and infertility in women. It may also be associated with fertility problems in men.