Dear Dr Nina: 'What tests will my doctor order for extremely painful periods?'
Q I have suffered from menstrual pains all my life. I am now in my late 30s. Recently, my periods have gotten worse and my last one lasted for about three weeks. I had a laparoscopy before, which revealed a bit of scarring, but nothing conclusive. My GP is referring me for tests as a result of the length of my recent period. What tests would these be and what would they be checking for?
Dr Nina replies: The medical term for painful periods is dysmenorrhoea. This is a very common condition. More than half of menstruating women will have some level of pain. In most cases, the pain is mild and only lasts one or two days, but in some cases, pain may be more severe and last longer.
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There are two types of dysmenorrhoea. Primary dysmenorrhoea starts within months of the first menstrual period. Secondary dysmenorrhoea usually comes on later in life. This pain is more likely to be associated with underlying problems and the pain may increase over time and last longer. Causes of secondary dysmenorrhoea include pelvic infection, endometriosis, a condition called adenomyosis where the tissue that usually lines the womb grows in the womb muscle, fibroids, which are growths in the wall of the womb, and narrowing of the cervix. It sounds like you have primary dysmenorrhoea.
Cramps that are not severe and only last one or two days may be normal and don't necessarily require review by a doctor. Severe prolonged pain should be checked. Your doctor can examine you, take swabs to rule out infection and may recommend an ultrasound or other exam to further recheck the womb and ovaries. Ultrasound can pick up changes such as uterine fibroids or ovarian cysts, which may contribute to the pain. If no obvious cause is found, specialist referral is advised.
The best way to diagnose endometriosis is by laparoscopy. This is what your doctor was looking for at laparoscopy. A gynaecologist can then see endometriosis if it is present.
Nearly all methods of contraception can help reduce menstrual pain. The implant and the coil may result in the absence of menstruation so no periods, no pain.
You said your periods are longer. This may be dysfunctional uterine bleeding. An underactive thyroid or polycystic ovarian syndrome are other causes. If you have not had blood recently, it is likely these will be arranged. Your consultant may also arrange a surgical procedure called a hysteroscopy. This allows them to directly view the inside of the womb. The lining of the womb may be scraped and sent for analysis (D&C) or a simple biopsy can be taken of the lining of the uterus.
In some women, changes in menstruation start early and continue for many years before menopause finally occurs. This change may simply be part of what is normal menstrual life for you, but your doctor is being thorough, so I'm sure any treatable cause will be found.