Abnormal Menstrual Odors and Pain: A Guide for Women

Menstrual odor

Hello Dr.
Lin,
I am unmarried and had a laparoscopic surgery around 1997 due to endometriosis, during which a portion of my left ovary was removed, and uterine fibroids were also excised.
I still have adenomyosis that has not been treated, and I have been experiencing dysmenorrhea.
I have some questions I would like to ask, thank you.
1.
About eight to nine days before my period starts, my abdomen becomes quite large, and I experience uterine cramping, along with pain in my lower left abdomen.
When my period begins, the pain is unbearable, especially in the lower left abdomen.
The pain is particularly intense at night after having endured it during the day.
Why is this happening?
2.
My menstrual flow is not heavy; I usually change four to five sanitary pads a day (only one or two days are heavier), but I do have blood clots.
I have iron deficiency anemia and often experience headaches and dizziness, which worsen during my period.
I wonder if this affects my menstrual flow.
It typically takes about eight days for my period to completely finish, with a cycle of approximately 26 days.
Is it possible that I am experiencing early menopause?
3.
It's strange; my menstrual blood used to have a normal metallic smell, but this time it has a foul odor, somewhat like a cadaveric smell, and is mostly brown in color.
The amount is not much, but I still experience significant abdominal pain.
What could be the reason for this? Is there a problem?
4.
My premenstrual symptoms are very pronounced, and the dysmenorrhea has not improved.
I wonder if the endometriosis is causing these issues or if there might be other underlying problems.
I have previously had a Pap smear that showed signs of inflammation; could this be affecting my condition?

tiā, 30~39 year old female. Ask Date: 2003/09/23

Dr. Lin Manying reply Obstetrics and Gynecology

1.
The presence of adenomyosis can still lead to dysmenorrhea.
Additionally, undergoing surgery for endometriosis does not guarantee a cure, as there is still a possibility of recurrence, necessitating regular follow-up.

2.
The menstrual blood volume you described is normal.
Typically, for individuals of reproductive age, the menstrual cycle interval is 28+7 or 28-7 days, averaging about a 26-day cycle.
This may be influenced by previous ovarian surgery, and if there is currently no desire for fertility, it falls within an acceptable range.

3.
Abnormal menstrual blood volume (especially a significant decrease) should first raise concerns about pregnancy or miscarriage.
If these are ruled out, one should consider the possibility of recurrence of the original endometriosis or changes in adenomyosis.

4.
In summary, you should regularly visit a gynecologist to monitor the issue of endometriosis (every 3-6 months) and discuss treatment options with your physician.
The choice of treatment is related to your current fertility desires and may involve surgery or aggressive medical therapy, such as hormonal agents.

Reply Date: 2003/09/23

More Info

Understanding abnormal menstrual odors and pain is crucial for women's health, especially for those with a history of conditions like endometriosis or uterine fibroids. Your symptoms suggest a complex interplay of hormonal changes, potential underlying conditions, and possibly even lifestyle factors. Let's break down your concerns systematically.

1. Premenstrual Pain and Cramping: The intense cramping you experience in the days leading up to your period, as well as the worsening pain at night, could be attributed to several factors. One possibility is that the hormonal fluctuations associated with your menstrual cycle are causing increased uterine contractions. Additionally, since you have a history of endometriosis, the presence of endometrial tissue outside the uterus can lead to significant pain, especially during menstruation. This tissue can become inflamed and cause cramping as it responds to hormonal changes. The pain radiating to the left lower abdomen may also indicate that the remaining ovarian tissue or other pelvic structures are involved.

2. Menstrual Flow and Iron Deficiency: Your description of the menstrual flow—changing from light to heavy with blood clots—combined with your history of iron deficiency anemia, raises concerns. Blood clots during menstruation can occur due to heavy bleeding, which can be exacerbated by conditions like fibroids or endometriosis. The fact that you experience increased dizziness and headaches during your period could indeed be linked to your anemia, as low iron levels can lead to insufficient oxygen delivery to tissues, resulting in fatigue and cognitive issues. The duration of your cycle (26 days) and the length of your periods (around eight days) are within the normal range, but if you notice significant changes, it may warrant further investigation.

3. Abnormal Odors: The change in the odor of your menstrual blood to a foul smell, described as "like corpse odor," is concerning. Normal menstrual blood has a metallic scent due to iron, but a strong, unpleasant odor can indicate an infection, such as bacterial vaginosis or pelvic inflammatory disease. The presence of brown blood is often old blood, which can be normal, but when combined with a foul smell, it suggests that you should consult a healthcare provider to rule out any infections or other complications.

4. Premenstrual Symptoms and Endometriosis: Your clear premenstrual symptoms and persistent dysmenorrhea (painful menstruation) could indeed be linked to your history of endometriosis. Endometriosis can cause chronic pelvic pain and may lead to more severe symptoms as you approach menopause due to hormonal changes. The inflammation noted in your previous Pap smear could also contribute to your symptoms, as chronic inflammation in the pelvic area can exacerbate pain.

Given your symptoms, it is advisable to seek a thorough evaluation from a gynecologist. They may recommend imaging studies such as an ultrasound or MRI to assess for any abnormalities in the pelvic region, including the presence of endometriosis, fibroids, or other structural issues. Additionally, a complete blood count (CBC) can help evaluate your anemia and check for signs of infection.

In terms of management, treatment options may include hormonal therapies to help regulate your menstrual cycle and alleviate pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) can also be effective for managing menstrual pain. If endometriosis is confirmed, more targeted treatments, including hormonal therapies or even surgical options, may be considered.

In conclusion, your symptoms warrant a comprehensive evaluation to determine the underlying causes and appropriate treatment. Do not hesitate to reach out to a healthcare provider to discuss your concerns and explore potential management strategies. Your health and comfort are paramount, and addressing these issues can significantly improve your quality of life.

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