Severe Menstrual Pain: Possible Causes and Solutions

Dysmenorrhea with severe pain in the right lower abdomen?

Hello Doctor: I started my menstruation around the age of 15.
Initially, there was no pain, but it became more severe over the years.
Around the age of 17, I visited a gynecology clinic, and the doctor prescribed me Danazol.
During the medication period, the severity of my dysmenorrhea decreased to the point where I didn't need painkillers.
However, during the month I stopped taking the medication, the pain became unbearable again.
Later, I went to a large hospital for examination, and the doctor informed me that I have a retroverted uterus and adenomyosis, but it is not severe and advised me to continue monitoring it.
Since then, I have been seeing a traditional Chinese medicine practitioner for body conditioning, with varying results.
When I experience higher stress, the pain becomes more severe.
On the first day of my period, I experience continuous pain, while the second and third days involve wave-like pain, starting from no pain to gradually becoming as painful as the first day, and then after a while, it returns to completely no pain.
Recently, in addition to the aforementioned pain, I have noticed that the pain has shifted from the center of the uterus to the area of the right ovary.
During my usual ovulation period, I experience pain in the lower right abdomen for about a day.
I would like to ask the doctor if my adenomyosis has worsened and if there are any lesions around the ovary as well?

HCI, 20~29 year old female. Ask Date: 2022/08/27

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, I recommend scheduling a follow-up appointment for relevant examinations to assess any changes.
In the meantime, we can manage your symptoms with medication.
Thank you! Wishing you peace and health.
Dr.
Chang

Reply Date: 2022/08/27

More Info

Severe menstrual pain, also known as dysmenorrhea, can be a debilitating condition that affects many individuals. It is essential to understand the potential causes and available solutions to manage this pain effectively. Based on your description, it appears that you have been experiencing worsening menstrual pain over the years, which has been diagnosed as uterine retroversion and adenomyosis. Let's delve into the possible causes and treatment options.

Possible Causes of Severe Menstrual Pain
1. Adenomyosis: This condition occurs when the tissue that normally lines the uterus (endometrium) grows into the muscular wall of the uterus. It can lead to heavy menstrual bleeding and severe cramping, particularly during the first few days of menstruation. The pain may be localized to the area of the uterus or radiate to the ovaries, as you have described.

2. Uterine Retroversion: A tilted uterus can sometimes contribute to discomfort during menstruation. While it is often a normal anatomical variation, in some cases, it may lead to increased pain during menstrual cycles.

3. Endometriosis: Although not mentioned in your previous diagnoses, endometriosis is another condition that can cause severe menstrual pain. It occurs when tissue similar to the lining inside the uterus grows outside of it, leading to inflammation, scarring, and pain.

4. Ovarian Issues: Pain localized to the right ovary during ovulation could indicate ovarian cysts or other ovarian conditions. These can cause significant discomfort and may require further evaluation.

5. Psychological Factors: Stress and anxiety can exacerbate the perception of pain. Given that you mentioned increased pain during periods of stress, it is crucial to consider the psychological aspect of pain management.

Treatment Options
1. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can be effective in managing menstrual pain. If you have been prescribed hormonal medications like birth control pills (e.g., Xinna), they can help regulate your menstrual cycle and reduce the severity of cramps. It is essential to discuss with your healthcare provider whether to continue or adjust your medication regimen.

2. Hormonal Therapy: For conditions like adenomyosis, hormonal treatments can help reduce the growth of endometrial tissue and alleviate pain. This may include hormonal contraceptives, progestins, or even GnRH agonists.

3. Lifestyle Modifications: Regular exercise, a balanced diet, and stress management techniques such as yoga or meditation can help reduce the severity of menstrual pain. Heat therapy, such as using a heating pad on the abdomen, can also provide relief.

4. Alternative Therapies: Acupuncture, chiropractic care, and herbal medicine may offer additional relief for some individuals. However, it is essential to consult with a qualified practitioner and your healthcare provider before starting any alternative treatments.

5. Surgical Options: In severe cases where conservative treatments fail, surgical options may be considered. This could involve procedures to remove endometrial tissue or, in some cases, a hysterectomy.

Conclusion
Given your history of adenomyosis and the recent changes in your pain pattern, it is advisable to follow up with your gynecologist for further evaluation. They may recommend imaging studies, such as an ultrasound or MRI, to assess the current state of your uterus and ovaries. It is crucial to address any concerns about worsening symptoms, as early intervention can lead to better management of your condition and improved quality of life. Remember, you are not alone in this, and there are various treatment options available to help manage your menstrual pain effectively.

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