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Pelvic Pain/Painful Periods

Menstruation is a normal and regular event in a woman's life.  Some women, however, have severe pain.  Painful menstruation is called dysmenorrhea. 

What is Menstrual Pain?

Menstrual cramps are often described as a dull ache or a sens of pressure in the lower abdomen.  Sometimes they come and go, growing stronger and then fading.  Sometimes they are a constant, dull ache.  The discomfort may spread to the hips, the lower back, and the inner thighs.  The vagina or the uterus may ache and feel heavy.  When cramps are severe, nausea, vomiting, pain, or general achiness can occur along with the pain.  Sometimes these symptoms can occur even if the cramps are mild.

Normal Sources of Menstrual Pain

The uterus is a muscle.  Like all muscles, it contracts and relaxes.  The contractions are caused by prostaglandins, natural substances in the walls of the uterus.  During strong contractions, the uterus may begin to contract too strongly or too frequently.  The blood supply to the uterus is cut off temporarily.  This deprives the muscle of oxygen, causing pain. 

Abnormal Sources of Menstrual Pain

  • Endometriosis - A condition in which tissue similar to that lining the uterus is found outside of the uterus, usually in the ovaries, fallopian tubes, and other pelvic structures
  • PID/Chronic Pelvic Pain - An infection, like chlamydia, in the fallopian tubes and nearby pelvic structures
  • Fibroids - benign masses in the uterine muscle that grow and may cause pain or bleeding

Treatments

Most menstrual pain syndromes can be treated effectively with antiprostaglandins or NSAIDS like ibuprofen or through hormonal regulators like birth control pills. 

Special Tests

When pain is unamenable to medication, sometimes a laparoscopy is performed to look directly inside lower abdomen to identify a source of pain.  This involves surgery and requires anesthesia. 

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