women s health issues
Menstrual Cramps
Evaluation of Menstrual Cramps
Doctors usually diagnose dysmenorrhea when a woman reports that she regularly has bothersome pain during menstrual periods. They then determine whether dysmenorrhea is primary or secondary. In women with dysmenorrhea, certain symptoms are cause for concern: Severe pain that began suddenly or is new Constant pain Fever A pus-like discharge from the vagina Sharp pain that worsens when the abdomen is touched gently or the person moves even slightly Women with any warning sign should see a doctor as soon as possible (usually the same day). If women without warning signs have more severe cramps than usual or have pain that lasts longer than usual, they should see a doctor within a few days. Other women who have menstrual cramps should call their doctor. The doctor can decide how quickly they need to be seen based on their other symptoms, age, and medical history. Doctors or other health care practitioners ask about the pain and the medical history, including the menstrual history. Practitioners then do a physical examination. What they find during the history and physical examination may suggest a cause of menstrual cramps and the tests that may need to be done (see table). For a complete menstrual history, practitioners ask a woman How old she was when menstrual periods started How many days they last How heavy they are How long the interval between periods is Whether periods are regular Whether spotting occurs between periods When symptoms occur in relation to periods Practitioners also ask the woman the following: How old she was when menstrual cramps began What other symptoms she has What the pain is like, including how severe it is, what relieves or worsens symptoms, and how symptoms interfere with her daily activities Whether she has pelvic pain unrelated to periods Whether nonsteroidal anti-inflammatory drugs (NSAIDs) help relieve the pain Whether she has pain during sexual activity or has had problems becoming pregnancy (as may occur in endometriosis) The woman is asked whether she has or has had disorders and other conditions that can cause cramps, including use of certain drugs (such as birth control pills) or an IUD. Practitioners ask whether she has had any surgical procedures that increase the risk of pelvic pain, such as a procedure that destroys or removes the lining of the uterus (endometrial ablation). A Pelvic Examination is done. Doctors check for abnormalities, including discharge, tenderness, polyps, and fibroids. Doctors also gently feel the abdomen to check for areas of particular tenderness, which may indicate severe inflammation in the abdomen ( Peritonitis ). Testing is done to rule out disorders that may be causing the pain. For most women, tests include A pregnancy test in all women of reproductive age Ultrasonography of the pelvis to check for fibroids, endometriosis, adenomyosis, and cysts in the ovaries If pelvic inflammatory disease is suspected, a sample of secretions is taken from the cervix, examined under a microscope, and sent to a laboratory to be tested. If results of these tests are unclear and symptoms persist, one or more of the following tests is done: Imaging tests such as Hysterosalpingography or Hysteroscopy to identify problems with the cervix or uterus (but not with the ovaries) Magnetic Resonance Imaging (MRI) (MRI) to identify other abnormalities Laparoscopy if results of other tests are unclear Forhysterosalpingography,x-rays are taken after a substance that can be seen on x-rays (radiopaque contrast agent) is injected through the cervix into the uterus and fallopian tubes. If results are unclear, magnetic resonance imaging (MRI) may be done. Forsonohysterography,ultrasonography is done after fluid is infused in the uterus through a thin tube inserted through the vagina and cervix. The fluid makes abnormalities easier to identity. Forhysteroscopy,doctors insert a thin viewing tube through the vagina and cervix to view the interior of the uterus. This procedure can be done in a doctor's office or in a hospital as an outpatient procedure. Forlaparoscopy,a viewing tube is inserted through a small incision just below the navel and is used to view the uterus, fallopian tubes, ovaries, and organs in the abdomen. This procedure is done in a hospital or surgical center. Laparoscopy enables doctors to directly view structures in the pelvis. 