Patient's question:
I am a severe menstrual cramp sufferer. A few days before my period starts, I begin to experience dull pain in my lower abdomen, along with brown discharge. The first and second days of my period are the most painful, accompanied by vomiting, diarrhea, frequent urination, and lower back and knee pain. The menstrual blood is very clear, and I can see pieces of detached endometrium coming out, which are about the size of meat cubes. Once these pieces are expelled, the pain completely stops. I am married but have not given birth. I have had an ultrasound, which did not reveal any issues. Could you please advise on any other methods to check for conditions like endometrial lesions or pelvic inflammatory disease?First follow-up question: I did not experience menstrual cramps at the time of my first period. It was only after two or three years, when I was 16 or 17, that I started experiencing them due to not paying attention.
Doctor's answer:
Hello: Based on your situation, it should be classified as dysmenorrhea.Causes of Dysmenorrhea:
Primary dysmenorrhea is generally believed to be attributed to the following reasons:
- Endometrial shedding (membranous dysmenorrhea)
- Uterine underdevelopment
- Uterine retroflexion
- Cervical stenosis
- Poor posture and constitutional factors
- Allergic states and psychological factors, etc.
Secondary Dysmenorrhea:
Secondary dysmenorrhea is diagnosed when pelvic organ abnormalities are found during bimanual examination. It is often misdiagnosed as primary dysmenorrhea when local abnormal signs are not yet apparent. Therefore, women with dysmenorrhea that begins more than 3 years after menarche should be considered for secondary dysmenorrhea and undergo further examination.
The most common cause of secondary dysmenorrhea in young women is endometriosis, which has symptoms very similar to primary dysmenorrhea. If the patient has progressive dysmenorrhea or a family history of endometriosis (with the mother or sister suffering from the condition), laparoscopic examination should be performed early to confirm the diagnosis and undergo conservative surgical treatment to preserve fertility.
Additionally, causes of secondary dysmenorrhea include:
- Congenital uterine malformations (including bicornuate uterus, septate uterus, unicornuate uterus, transverse vaginal septum, etc.)
- Pelvic inflammation
- Uterine adenomyosis
- Uterine fibroids
- Uterine polyps
- Uterine adhesions
- Cervical stenosis
- Ovarian cysts
- Pelvic congestion syndrome, etc.
In addition to dysmenorrhea, elevated body temperature during menstruation should be considered a sign of pelvic inflammation. Approximately 5% of women with an intrauterine device (IUD) experience dysmenorrhea. If there is no infection, the cause of dysmenorrhea may be IUD irritation of the endometrium, leading to excessive release of prostaglandins (PGs) and excessive uterine muscle contraction.
Uterine malformations, reproductive tract