Painful Periods

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[edit] Painful Periods

Periods can be very painful because of various reasons. For instance, a narrow cervical canal requires more force of the uterus to empty itself with a menstrual period.

The smooth muscle cells of the uterus are equipped to work against resistance as with a successful pregnancy the baby has to be expelled against resistance. With a small cervical canal it is like the woman has to go through labor pains with every period. The specialist (gynecologist) can help here by dilating cervix with a surgical procedure under an anesthetic. This is commonly known as a D&C ("dilatation and curretage"), which often can be done as an outpatient with a daycare procedure. Other conditions can also lead to such painful periods, for instance uterus polyps or cervix polyps. Endometriosis and adenomyosis are also often causing painful periods and have been described under this link.

Other women have painful periods with a retroverted uterus and in these cases painful periods tend to run in the family. However, the doctor can often work out a drug regimen with anti-inflammatory drugs where this is taken just for a few days before the periods would have been painful in the past.

[edit] Endometriosis

This is a disorder where the lining of the uterus (called "endometrium") migrates through the fallopian tubes to one or both ovaries where it forms cysts on the ovary. This is non- malignant, but very painful and fluctuates in symptoms with the normal periods as the endometrium still undergoes the cyclical transformation outside the uterus as it does inside. The bleeding around the period time into the abdominal cavity produces most of the symptoms of endometriosis. Lesions can also grow on the outside surface of the uterus. Here are a few facts you may want to know:

Some facts about endometriosis
Percentage of women:	Comments:
10% to 15%	of women between 25 and 45 years of age have endometriosis
30% to 50%	of infertile women have endometriosis

Endometriosis symptoms:

The main symptoms of endometriosis are lower abdominal pain
and pelvic pain, heavy period, irregular periods and infertility. The physician may feel a pelvic mass on pelvic examination.

The woman may give a history of painful periods (dysmenorrhea) while in the past she always had pain-free periods. She might also disclose that she has painful sex shortly before or around the time of her period (called"dyspareunia"). If there is bladder endometriosis or colon endometriosis, there might be lower abdominal pain, pain during urination and rectal bleeding during menstruation. On the other hand endometriosis on the ovaries can grow deeper into the ovarian tissue and form cysts (called "endometriomas") into which it bleeds every 28 days. The blood can experience a transformation and turn dark brown (called "chocolate cysts", often measuring 2.5 cm or 1 inch in diameter).

The cysts can also develop between the ovary and the large intestine or the bladder causing a pelvic mass that is glued together with chocolate cysts. Sometimes bowel obstruction can occur with such a complex mass, which might be the first clinical presentation of endometriosis, diagnosed during an assessment of acute abdominal pain at the Emergency Room of the hospital. The good news in this situation is that the bowel obastruction is not cancerous. The bad news is that it still requires major surgery to correct the condition. Sometimes the scarring after such a surgery might lead to further bowel obstruction from adhesions. They consist of fibrous bands between bowel loops associated with abdominal pain and occasionally it can also cause bowel obstruction. Surgery may be required again at that point to take care of the adhesions.Adenomyosis may simply be a variation of endometriosis, where the endometrium is invading the uterine wall.

Endometriosis treatment:

Before the gynecologist will do anything, there needs to be a thorough assessment of what is going on. Depending on the symptoms this might involve a pelvic ultrasound case study, a voiding cystourethrogram (=X-rays of bladder and ureters), a Barium enema (=X-rays of the rectum and sigmoid colon), and possibly an MRI or CT scan. There might be some blood tests required for serum cancer antigen-125 as well as anti-endometrial antibody levels. The gynecologist may also want to do infertility studies, if there is an infertility problem. There are 4 stages of endometriosis that have been defined:

Staging of endometriosis
Stage:	Description of findings:
1	minimal endometriosis with only a few superficial lesions
2	mild endometriosis with more deeply implanted lesions
3	moderate endometriosis with several deep implants and also small endometriomas on one or both ovaries
4	severe endometriosis with many deep lesions, large endometriomas, often on both ovaries and often causing dense adhesions between the back portion of the uterus and the rectum

The treatment by the gynecologist will vary according to the stage found. In stages 1 and 2 the gynecologist may want to use a medical approach with several different medications such continuous birth control pill, danazol (brand names: Danocrine, Cyclomen) or a short treatment period of gonadotropin-releasing hormone analogue (brand name: Synarel).

However, Synarel cannot be given longer than 6 months because of osteoporosis as side effect with prolonged use. Pregnancy rates with medical treatment are 40% to 60%. If medical treatment fails in stages 1 and 2, or for stages 3 and 4 surgery would be required. Laparoscopic surgery can remove smaller endometriosis lesions, cauterize them, vaporize or excise them by laser surgery.

With surgical treatments pregnancy rates are 40% to 70%, but the higher the stage of endometriosis the lower the success rate. Abdominal hysterectomy is reserved for patients with severe pelvic pain that has not responded to any of the other measures, and where the women have finished the reproductive phase in their lives (all child wishes have been fulfilled). Usually the ovaries have to be removed along with the uterus (ovariectomy). Following the hysterectomy and ovariectomy hormone replacement therapy is started using estrogen. However, if some endometriosis lesions had to be left behind, continuous progestin therapy has to be given along with the estrogen to prevent malignant transformation into endometrial (=uterine) cancer in future.

Adenomyosis is treated very successfully with a hysterectomy either through the vaginal approach or the abdominal approach, occasionally also if feasible through the abdominal laparoscopic approach.

Women's Health

Infertility

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