Severe Menstrual Pain: When to Seek Medical Help

Menstrual pain has persisted for a long time?

Hello, doctor.
I have a gynecological issue I would like to consult you about.
This time, my menstrual period has caused severe pain in my lower abdomen, ranging from above the pubic area to around the navel.
The pain has persisted throughout the entire 7-day period.
In the past, I would only feel a bit of discomfort on the first day of my period, but this time the pain has been so intense that I couldn't go out.
I also have pain in my gastrointestinal tract and head, with no appetite; forcing myself to eat makes me feel worse.
The pain comes and goes, but when it does occur, I experience diarrhea and cold sweats, although I don't pass much when I go to the bathroom.
When lying down, it feels like my entire abdomen, from the lower abdomen to the stomach, is in pain, but when it's not painful, I only feel a bit of heaviness.
Previously, I would have blood clots during my period, and this time there were slightly more clots, but the overall menstrual flow is similar to before.
I thought it might be due to consuming too many cold foods, so I visited a traditional Chinese medicine practitioner.
However, even five days after my period ended, I still experience sudden abdominal pain similar to menstrual cramps.
Although the pain subsides after a while, I still have occasional discomfort even after my period has ended, and pressing on my lower abdomen causes some heaviness and pain.
I find this very strange and am starting to lose track of whether this is a menstrual issue or a gastrointestinal issue.
Should I get checked out? If so, should I see a gynecologist or a gastroenterologist? Thank you, doctor, for taking the time to answer my questions.

Xiao E, 20~29 year old female. Ask Date: 2018/07/18

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the symptoms of dysmenorrhea can include not only cramping pain in the lower abdomen during menstruation but also nausea, vomiting, headaches, anxiety, fatigue, diarrhea, dizziness, bloating, breast tenderness, mood swings, back pain, and fainting.
The onset of symptoms can occur 1-2 days before menstruation or during the menstrual period, with the most severe symptoms typically occurring in the first 48 hours.
It is estimated that 80-90% of women experience some form of dysmenorrhea, with varying degrees of severity, which can often impact work or academic performance.
Therefore, accurate diagnosis and treatment can help improve quality of life and work efficiency.
Dysmenorrhea can generally be classified into primary and secondary types:
1.
Primary dysmenorrhea: This is caused by intrinsic mechanisms within the uterus, with no abnormalities in the pelvic structures; pelvic examinations and ultrasounds are normal.
Symptoms often begin 1-2 years after menarche, peaking between the ages of 23-27.
Women who experience early menarche, have heavier menstrual flow, have never given birth, are obese, have a high socioeconomic status, are single, or are under stress may experience more severe symptoms.
Symptoms typically improve with age or after childbirth.
2.
Secondary dysmenorrhea: This arises from pathological changes in the pelvic organs, such as adenomyosis, endometriosis, uterine fibroids, endometrial polyps, pelvic inflammatory disease, or the presence of an intrauterine device (IUD), which can all be contributing factors.
These pathological conditions may also be associated with infertility and dyspareunia, and treatment methods vary depending on the underlying cause.
If your symptoms persist or worsen, it is advisable to consult a gynecologist for examination and treatment.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2018/07/18

More Info

Severe menstrual pain, also known as dysmenorrhea, can be a debilitating experience for many women. Your description of pain that extends from the pubic area to the navel, accompanied by gastrointestinal symptoms such as nausea and diarrhea, suggests that you may be experiencing more than just typical menstrual cramps. Given that your pain has persisted beyond your menstrual cycle and is affecting your daily activities, it is crucial to seek medical attention.

Dysmenorrhea can be classified into two types: primary and secondary. Primary dysmenorrhea is common and typically occurs due to the release of prostaglandins, which are chemicals that cause the uterus to contract. Secondary dysmenorrhea, on the other hand, is often caused by underlying conditions such as endometriosis, fibroids, or pelvic inflammatory disease. The fact that you are experiencing significant pain that disrupts your daily life, along with gastrointestinal symptoms, raises the possibility of secondary dysmenorrhea or another underlying condition.

It is essential to monitor the severity and duration of your symptoms. If your pain is severe enough to prevent you from engaging in normal activities, such as going out or eating, this is a clear indication that you should seek medical help. Additionally, the presence of gastrointestinal symptoms, such as diarrhea and nausea, could suggest a possible connection between your menstrual cycle and digestive issues, which may require further investigation.

In terms of what type of specialist to see, it would be advisable to start with a gynecologist. They can perform a thorough evaluation, including a pelvic exam, and may recommend imaging studies such as an ultrasound to check for conditions like ovarian cysts or fibroids. If the gynecologist determines that your symptoms may be related to gastrointestinal issues, they can refer you to a gastroenterologist for further evaluation.

In the meantime, there are several self-care measures you can take to help manage your pain. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be effective in relieving menstrual pain. Heat therapy, such as using a heating pad on your abdomen, may also provide comfort. Additionally, gentle exercise, relaxation techniques, and dietary adjustments may help alleviate some symptoms.

It is important to listen to your body and not dismiss these symptoms as merely part of your menstrual cycle. Persistent or severe pain is a signal that something may be wrong, and early intervention can lead to better outcomes. If you find that your symptoms worsen or do not improve with self-care measures, do not hesitate to seek medical attention. Your health and well-being should always be a priority.

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