Menstrual Pain: When to Seek Help from a Gynecologist

Dysmenorrhea

Hello, doctor! I would like to ask about my menstrual cycle, which is usually very regular, around 28 days.
Previously, I experienced only mild lower abdominal pain and slight lower back discomfort during my period, sometimes even feeling nothing at all, and I didn't need to take painkillers.
However, in the past year or two, on the first and second days of my period, I sometimes experience nausea and vomiting.
Recently, the lower abdominal pain has become quite severe, and the lower back pain is also significant, often to the point where I can't attend class.
In the last two or three cycles, I took painkillers, but they didn't seem to help much.
I read some reports stating that menstrual pain tends to decrease with age, but why is my situation the exact opposite? Is this condition considered normal? Should I see a gynecologist for an examination? If I need to go to the hospital, what kind of tests would be performed? (I'm a bit scared since it would be my first visit to a gynecologist...)

Xiao Wugui, 20~29 year old female. Ask Date: 2004/10/01

Dr. Zhou Dali reply Obstetrics and Gynecology

Mild abdominal discomfort and lower back pain during menstruation are normal responses, and these symptoms are common among young women who have not given birth.
However, if the menstrual cramps are severe, it is necessary to seek evaluation at a clinic.
Typically, a medical history will be taken, and an abdominal ultrasound may be performed.
Please do not hesitate to seek appropriate medical care.

Reply Date: 2004/10/01

More Info

Menstrual pain, also known as dysmenorrhea, can vary significantly among individuals and can change over time. Your experience of having mild discomfort during your menstrual periods in the past, which has now escalated to severe pain accompanied by nausea and significant discomfort, is concerning and warrants further evaluation.

Firstly, it’s important to understand that menstrual pain can be classified into two categories: primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea is typically associated with the natural process of menstruation and is often due to the release of prostaglandins, which are chemicals that cause the uterus to contract. This type of pain usually begins shortly before or at the onset of menstruation and can last for a few days. Secondary dysmenorrhea, on the other hand, is caused by underlying reproductive health issues such as endometriosis, fibroids, or pelvic inflammatory disease.
Given that your symptoms have worsened over the past couple of years, it is essential to consider the possibility of secondary dysmenorrhea. The presence of nausea and severe pain, especially if it interferes with your daily activities like attending classes, suggests that there may be an underlying condition that needs to be addressed.
You mentioned that you have been taking pain relief medication, but it has not been effective. This could indicate that the pain is more complex than typical menstrual cramps and may require a different approach to management. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are commonly used for menstrual pain, but if they are not providing relief, it may be time to consult a gynecologist for a comprehensive evaluation.

When you visit a gynecologist, they will likely start with a thorough medical history and physical examination. They may ask about the nature of your pain, its timing, and any other symptoms you may be experiencing. Following this, they might recommend several diagnostic tests, including:
1. Pelvic Ultrasound: This imaging test can help identify any structural abnormalities in the reproductive organs, such as ovarian cysts, fibroids, or signs of endometriosis.

2. Transvaginal Ultrasound: This is a more detailed ultrasound that can provide better images of the uterus and ovaries, especially if there are concerns about conditions like endometriosis.

3. Blood Tests: These can help rule out other conditions and assess overall health, including hormone levels.

4. Laparoscopy: In some cases, if endometriosis or other conditions are suspected, a minimally invasive surgical procedure called laparoscopy may be performed. This allows the doctor to view the pelvic organs directly and potentially treat any abnormalities found.

It is understandable to feel apprehensive about visiting a gynecologist, especially if it’s your first time. However, it’s important to remember that gynecologists are trained to handle a variety of issues related to menstrual health and can provide you with the support and treatment you need.
In conclusion, your worsening symptoms are not typical and should be evaluated by a healthcare professional. Seeking help from a gynecologist is a proactive step toward understanding and managing your menstrual pain effectively. Early diagnosis and treatment can significantly improve your quality of life and help you regain control over your menstrual health.

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