Abdominal Pain During Menstruation: When to Seek Help - Obstetrics and Gynecology

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Understanding abdominal pain during menstruation can be complex, as it may stem from various causes, including gynecological and gastrointestinal issues. Given your description of the pain occurring around the fourth or fifth day of your menstrual cycle, it is essential to consider both menstrual-related factors and potential gastrointestinal concerns.

Menstrual pain, or dysmenorrhea, typically presents as cramping pain in the lower abdomen, often peaking on the first day of menstruation. However, some women experience discomfort that extends beyond typical menstrual cramps. This could be due to several factors, including hormonal changes, the presence of fibroids, endometriosis, or other pelvic conditions. Endometriosis, for instance, occurs when tissue similar to the lining of the uterus grows outside it, leading to pain that may not be confined to the menstrual period.

Your description of the pain feeling like something is "twisting" inside could suggest a few possibilities. If the pain is localized and sharp, it might indicate an issue with the ovaries, such as ovarian cysts or even ovulation pain (mittelschmerz), which can occur mid-cycle but may also be felt later in the cycle. Alternatively, gastrointestinal issues such as irritable bowel syndrome (IBS) or constipation could also manifest as abdominal discomfort that coincides with your menstrual cycle, particularly if hormonal changes affect gut motility.

Given that this pain is distinct from your typical menstrual cramps and has persisted for four months, it would be prudent to seek medical advice. You should consider visiting a healthcare provider who specializes in women's health, such as a gynecologist. They can perform a thorough evaluation, which may include a pelvic exam, ultrasound, or other imaging studies to rule out any structural abnormalities or conditions like endometriosis or fibroids.

If your gynecologist determines that your symptoms may be related to gastrointestinal issues, they may refer you to a gastroenterologist for further evaluation. This could include tests to assess for conditions like IBS, inflammatory bowel disease (IBD), or other digestive disorders.

In summary, while the pain you are experiencing could be related to your menstrual cycle, it is essential to differentiate it from other potential causes. Given the duration and nature of your symptoms, seeking medical attention is advisable. A gynecologist would be a good starting point, and they can guide you on whether further evaluation by a gastroenterologist is necessary. Early intervention can lead to better management of your symptoms and overall health.