Lower Abdominal Pain During Menstruation: Causes and Solutions

Pain in the lower abdomen during menstruation?

Since December 2018, my menstrual flow has been heavy and lasted more than 7 days.
In July 2019, I went to Chang Gung Memorial Hospital for a dilation and curettage (D&C) to remove the excess endometrial tissue, and the results came back normal.
After that, my menstrual flow decreased, but I began experiencing pain in the lower abdomen (about 5-7 fingerbreadths below the navel, above the incision from a previous laparotomy).
The pain lasts for 7-10 days and occurs when pressure is applied or during abdominal exertion (including normal bowel movements and lifting children).
A gynecologist suggested it might be uterine fibroids and prescribed birth control pills, which should alleviate the pain.
However, after taking the pills for three cycles, the situation remains the same.
On the first day of my period, I had an ultrasound that indicated a suspected 1.3 cm uterine fibroid, but the doctor was unsure why I still experience pain despite taking the birth control pills.
1.
Should I go to a larger hospital for further examination? Which department should I visit? Gynecology, gastroenterology, or another specialty?
2.
Besides uterine fibroids, is there a possibility that this could be cancer? I would appreciate any reassurance from the doctor.
Thank you, a concerned mother of two.
P.S.
I had an emergency cesarean section on September 28, 2018, due to preeclampsia and fetal distress at 32 weeks and 1 day, and I was intubated and admitted to the ICU the next day.
I am unsure if this is related.

Celia, 30~39 year old female. Ask Date: 2020/09/16

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the causes of menstrual pain and abdominal pain in women are numerous.
It is advisable to consult a physician for further evaluation if the symptoms persist or worsen.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2020/09/16

More Info

Lower abdominal pain during menstruation can be a distressing experience, and understanding its causes is crucial for effective management. Based on the information provided, it appears that you have been experiencing significant menstrual changes and associated pain for several years. Here’s a comprehensive overview of potential causes, diagnostic approaches, and treatment options.

Potential Causes of Lower Abdominal Pain
1. Uterine Fibroids: As mentioned by your gynecologist, uterine fibroids (leiomyomas) are benign tumors that can develop in the uterus. They can cause heavy menstrual bleeding, prolonged periods, and pelvic pain. The size and location of fibroids can significantly influence symptoms. A 1.3 cm fibroid may not seem large, but its position could still lead to discomfort, especially if it exerts pressure on surrounding structures.

2. Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside the uterus, leading to inflammation, pain, and often heavy menstrual bleeding. Endometriosis can cause pain during menstruation and may also result in chronic pelvic pain.

3. Pelvic Inflammatory Disease (PID): This is an infection of the female reproductive organs that can cause pain and discomfort. PID can result from sexually transmitted infections and may lead to scarring and chronic pain if left untreated.

4. Ovarian Cysts: Functional ovarian cysts can develop during the menstrual cycle and may cause pain, especially if they rupture or become large.

5. Other Gynecological Issues: Conditions such as adenomyosis (where the inner lining of the uterus breaks through the muscle wall) or even benign tumors in the ovaries can lead to similar symptoms.

6. Gastrointestinal Issues: Sometimes, gastrointestinal problems such as irritable bowel syndrome (IBS) or constipation can mimic gynecological pain. Given that you mentioned pain during bowel movements, this could be a contributing factor.

Diagnostic Approaches
Given your history and ongoing symptoms, it is advisable to seek further evaluation. Here are some recommendations:
1. Gynecological Evaluation: Since your symptoms are closely related to your menstrual cycle, a visit to a gynecologist is essential. They may recommend further imaging studies, such as a pelvic ultrasound or MRI, to assess the size and impact of any fibroids or other abnormalities.

2. Gastroenterology Consultation: If gastrointestinal issues are suspected, a consultation with a gastroenterologist may be beneficial. They can evaluate for conditions like IBS or other digestive disorders that could contribute to your symptoms.

3. Pain Management Specialist: If pain persists despite treatment, a referral to a pain management specialist may help in developing a comprehensive pain management plan.

Treatment Options
1. Medications: Hormonal treatments, such as birth control pills, are often prescribed to manage symptoms associated with fibroids and endometriosis. If these have not been effective, discussing alternative hormonal therapies or non-hormonal options with your doctor may be necessary.

2. Surgical Options: If fibroids are confirmed and are significantly impacting your quality of life, surgical options such as myomectomy (removal of fibroids) or hysterectomy (removal of the uterus) may be considered.

3. Lifestyle Modifications: Regular exercise, a balanced diet, and stress management techniques can help alleviate some symptoms associated with menstrual pain.

4. Alternative Therapies: Some patients find relief through acupuncture, physical therapy, or dietary changes. Discussing these options with your healthcare provider may provide additional avenues for relief.

Cancer Concerns
While it is natural to worry about the possibility of cancer, especially with a family history of malignancies, it is important to note that most cases of lower abdominal pain related to menstruation are due to benign conditions. However, if there are concerning symptoms such as significant changes in menstrual patterns, unexpected weight loss, or persistent pain that does not respond to treatment, further evaluation may be warranted to rule out malignancies.

In conclusion, it is crucial to continue working closely with your healthcare providers to explore these symptoms comprehensively. Seeking a second opinion or further evaluation at a larger medical facility may provide additional insights and peace of mind. Your health and well-being are paramount, and addressing these concerns proactively is essential.

Similar Q&A

Understanding Left Lower Abdominal Pain Before Menstruation: Causes and Concerns

In the days leading up to menstruation, experiencing intermittent pain in the lower left abdomen, which resolves after the menstrual period, along with an increase in abnormal vaginal discharge, could indicate several possibilities. This may be related to premenstrual syndrome (P...

Dr. Lin Manying reply Obstetrics and Gynecology
A preliminary ultrasound and pelvic examination are required for diagnosis; it is recommended to visit an outpatient clinic for evaluation.

Understanding Abdominal Pain: A Comprehensive Guide for Women

Doctor, my friend is 37 years old and has been experiencing abdominal pain after her menstrual period for the past few months. Sometimes, the pain also occurs before her period. Her menstrual flow is normal, but at times the pain is severe enough to affect her rectal area, althou...

Dr. Chen Taicheng reply Family Medicine
● It is important to first determine whether abdominal pain is related to menstruation. Discomfort experienced before menstruation is referred to as premenstrual syndrome (PMS), with common symptoms including breast tenderness, abdominal bloating, diarrhea, mood swings, sleep dis...

Understanding Severe Lower Abdominal Pain During Menstruation: Causes and Solutions

On the first day of menstruation, there is severe pain in the lower abdomen on the right side, and the same pain persists on the second day, along with a decrease in menstrual flow. By the third day, the amount of blood is very minimal or there is no menstrual flow at all. This h...

Dr. Tian Yiwen reply Obstetrics and Gynecology
If you experience abnormal abdominal pain, please visit the obstetrics and gynecology outpatient clinic for an examination.

Understanding Abdominal Pain and Bowel Changes Before and During Menstruation

Hello, I experience a strong urge to have a bowel movement before, during, and after my menstrual period, accompanied by pain in the lower abdomen, just below the navel. The pain is so intense that it makes it difficult to exert myself during bowel movements, which are also soft ...

Dr. Lin Manying reply Obstetrics and Gynecology
Ms. Ke: Hello, regarding the first issue you described, an ultrasound examination will be conducted. As for the second issue, Western medicine theories suggest there is no correlation. Hualien Hospital, Ministry of Health and Welfare, cares about your health.