painful periods

• Primary Dysmenorrhea


  Menstrual pain typically starts 1-2 days before menstruation and lasts 2-3 days into the period. Pain is usually crampy and located in the lower abdomen but may radiate to the lower back or thighs. It is often accompanied by nausea, vomiting, diarrhea, fatigue, and headache.
• Endometriosis


  Painful periods that worsen over time, often accompanied by chronic pelvic pain throughout the menstrual cycle. Pain may be severe and debilitating, interfering with daily activities. Other symptoms may include pain during intercourse (dyspareunia), heavy menstrual bleeding, infertility, and gastrointestinal symptoms such as diarrhea or constipation during menstruation.
• Adenomyosis


  Similar to endometriosis, adenomyosis causes severe, crampy pelvic pain during menstruation, often associated with heavy menstrual bleeding and enlarged uterus. Pain may also occur between periods and during intercourse.
• Fibroids (Uterine Leiomyomas)


  Menstrual pain accompanied by heavy menstrual bleeding, pelvic pressure or fullness, frequent urination, and pain during intercourse. The pain may be localized to the lower abdomen or pelvis, and it may worsen with certain movements or positions.
• Pelvic Inflammatory Disease (PID)


  Menstrual pain accompanied by fever, abnormal vaginal discharge (e.g., foul-smelling, increased amount), pain during urination, pain during intercourse, and irregular menstrual bleeding. Other symptoms may include nausea, vomiting, and general malaise.
• Ovarian Cysts


  Menstrual pain accompanied by pelvic pressure or fullness, bloating, changes in bowel habits, and irregular menstrual bleeding. Severe cases may present with sudden, sharp pelvic pain, which could indicate ovarian torsion or rupture of the cyst.
• Cervical Stenosis


  Menstrual pain that is severe and localized to the lower abdomen, often described as cramping or pressure. Pain may be associated with difficulty passing menstrual flow, resulting in light or irregular periods.
• Uterine Polyps


  Menstrual pain accompanied by irregular menstrual bleeding, including spotting between periods or heavy periods. Pain may be localized to the lower abdomen or pelvis and may worsen with certain movements or positions.
• Pelvic Congestion Syndrome


  Menstrual pain that worsens over the course of the menstrual cycle and is accompanied by pelvic pressure or fullness, varicose veins in the pelvic area, and discomfort during intercourse. Pain may also improve with lying down.
• IUD-related Issues (e.g., expulsion, perforation)


  Menstrual pain accompanied by irregular bleeding, especially if onset coincides with IUD placement. Other symptoms may include vaginal bleeding after intercourse, pelvic pain unrelated to menstruation, and signs of infection (fever, abnormal discharge).
• Primary Dysmenorrhea


  Diagnosis: Based on clinical history and physical examination. No specific diagnostic tests are usually necessary.
• Primary Dysmenorrhea Management


  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief

  2. Hormonal contraceptives (birth control pills, patches, rings) may also help reduce menstrual pain by regulating hormonal fluctuations

  3. Heat therapy and regular exercise can provide additional relief
• Endometriosis Diagnosis


  Laparoscopy is the gold standard for diagnosing endometriosis. Imaging studies such as ultrasound or MRI may be used to evaluate pelvic structures.
• Endometriosis Management


  1. Pain medication (NSAIDs)

  2. Hormonal therapy (birth control pills, progestins, GnRH agonists)

  3. Surgery (laparoscopic excision or ablation of endometriotic lesions). In severe cases or when fertility is a concern, more extensive surgery may be necessary.
• Adenomyosis Diagnosis


  Transvaginal ultrasound may show thickening of the uterine wall. Definitive diagnosis often requires histopathological examination of the uterus after hysterectomy.
• Adenomyosis Management


  1. Pain medication (NSAIDs)

  2. Hormonal therapy (birth control pills, progestins, GnRH agonists)

  3. Surgical options such as hysterectomy in severe cases
• Fibroids (Uterine Leiomyomas) Diagnosis

  Pelvic ultrasound is the primary imaging modality for diagnosing fibroids. MRI may be used for further evaluation.
• Fibroids (Uterine Leiomyomas) Management


  1. Observation

  2. Medication (NSAIDs, hormonal therapy)

  3. Minimally invasive procedures (uterine artery embolization, MRI-guided focused ultrasound)

  4. Surgery (myomectomy, hysterectomy) depending on the size, number, and location of fibroids and the severity of symptoms
• Pelvic Inflammatory Disease (PID) Diagnosis


  Clinical diagnosis based on history, physical examination, and laboratory tests (e.g., cervical swab for gonorrhea and chlamydia, blood tests for inflammatory markers)
• Pelvic Inflammatory Disease (PID) Management


  1. Antibiotic therapy targeting common pathogens (e.g., ceftriaxone plus doxycycline) to cover gonorrhea, chlamydia, and other possible causative organisms

  2. Partners should also be treated to prevent reinfection
• Ovarian Cysts Diagnosis


  Transvaginal ultrasound is the primary imaging modality for diagnosing ovarian cysts. MRI may be used for further evaluation.
• Ovarian Cysts Management


  1. Observation

  2. Hormonal therapy (birth control pills)

  3. Surgery (cystectomy, oophorectomy) may be indicated in certain cases, especially if the cyst is large, persistent, or causing symptoms
• Cervical Stenosis Diagnosis


  Clinical examination may reveal difficulty passing a uterine sound or menstrual flow through the cervix.
• Cervical Stenosis Management


  Cervical dilation under anesthesia to relieve stenosis and alleviate symptoms
• Uterine Polyps Diagnosis


  Transvaginal ultrasound or hysteroscopy may be used to visualize uterine polyps.
• Uterine Polyps Management


  1. Observation

  2. Hormonal therapy (birth control pills)

  3. Hysteroscopic removal of polyps
• Pelvic Congestion Syndrome Diagnosis


  Clinical diagnosis based on history, physical examination, and imaging studies such as pelvic venography or pelvic ultrasound to evaluate venous congestion.
• Pelvic Congestion Syndrome Management


  1. Pain medication

  2. Hormonal therapy (to suppress ovarian function)

  3. Minimally invasive procedures (embolization of pelvic veins)

  4. Surgical options (ligation of ovarian veins, hysterectomy) in severe cases
• IUD-related Issues Diagnosis


  Clinical examination and imaging studies (ultrasound) may be used to assess IUD placement and detect complications such as perforation or expulsion.
• IUD-related Issues Management


  1. IUD repositioning, removal, or replacement may be necessary

  2. Antibiotic therapy may be indicated if infection is present
• DYSMENORRHOEA Management:

  – Stop smoking (clear link between smoking and dysmenorrhoea)

  – 1st line is NSAIDs (these inhibit prostaglandin synthesis) +/- paracetamol

  – 2nd line is combined oral contraceptive pill