Menstrual Pain: what are the origins?

MENSTRUAL PAIN is a very common and sometimes debilitating pelvic pain called Algomenorrhea or

menstrual pain

Menstrual pain is also called dysmenorrhea or algomenorrhea.

Dysmenorrhea. Clinical picture ranges from very mild forms (the most common) to forms so intense to hamper normal activities and require use of medicines. Dysmenorrhea or Algomenorrhea symptoms are characterized by pelvic pain sometimes associated with nausea, diarrhea, vomiting, headache and typically occur by the second day of menstrual cycle.

Distinction is usually made between primary and secondary Dysmenorrhoea.

Primary Dysmenorrhea onset at young age. We know little or nothing about its real causes. We certainly know  that it is linked to ovulation (women who do not ovulate do not have this disease) and to some mediator substances of inflammation. All this had indeed important therapeutic implications in using the pill and NSAIDs (nonsteroidal anti-inflammatory drugs), the main cornerstones of therapeutic approach.

Secondary Dysmenorrhea should be regarded as a clinical entity completely different from the primary Dysmenorrhea. It typically begins in adulthood and always after a long period of symptoms absence, in most cases due to well known reasons as Endometriosis, Adenomyosis, pelvic inflammation, uterine fibromatosis, cervical stenosis, uterine polyps presence, endopelvic adhesions syndromes, intrauterine devices insertion (IUDs). Conditions are not always identificable and it is necessary to carefully look for them. Their tratment is the basis for a symptoms resolution.

Pelvic examination is a critical step in the differential diagnosis. It can sometimes follow complementary surveys of undoubted utility as ultrasound pelvic tests, infectious disease tests as vaginal and cervical swab, a serum CA 125 dosage, the evaluation of some inflammatory markers such as ESR and CRP, the evaluation of Blood Count and and a urine test.  In some cases laparoscopy may also be indicated.

Surgical therapy has an important role only in some forms of secondary Dysmenorrhea. It is a very sensitive subject and for some even controversial issues I deliberately do not want to deal with in this article.

My advice is to not neglect Dysmenorrhea, especially when it has the secondary Dysmenorrhea characteristics or it prevents normal daily activities.

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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