Among the medical conditions that can cause menstrual pain are pelvic inflammatory disease, fibroids, endometriosis, and adenomyosis.

Pelvic inflammatory disease (infection of the cervix, uterus, fallopian tubes, and/or ovaries, usually associated with sexually transmitted diseases) may cause no symptoms whatsoever, or it may cause dull, constant pain in the lower abdomen, not only during your period but at other times.

Fibroids, which are noncancerous growths of the uterine wall, do not necessarily cause pain during menstruation or at any time, and many women with fibroids do not know they have them. However, fibroids may press on nerves within the pelvis and cause backache or abdominal heaviness not necessarily related to the menstrual cycle. Or sometimes the uterus may “decide” that a fibroid is a foreign body and begin contracting, trying to expel it. Fibroids can, however, cause heavy menstrual bleeding.

Endometriosis, a condition in which the tissue normally lining the uterus somehow migrates to other locations within the body, causes pain during the menstrual period and sometimes at other times of the month. This tissue responds to hormones just as if it were in its normal location inside the uterus: it swells and breaks down and bleeds. Since it has no natural exit, it bleeds into the abdominal cavity or surrounding tissues.

Adenomyosis, which used to be called internal endometriosis, is a sort of reverse endometriosis, in which the endometrial tissue turns inward and invades the muscular wall of the uterus beneath the endometrium. Like all endometrial tissue, wherever it may be, adenomyosis responds to hormones and bleeds into the surrounding tissues at the time of the menstrual period. Unlike endometriosis, which is a disease of younger women without children, adenomyosis usually targets women in their 30s and 40s who have already given birth several times. Women who have had a cesarean section or a D&C are also at increased risk. Researchers believe that pregnancy, labor, and the shrinking of the uterus after delivery may damage the uterine wall, allowing small islands of normal endometrial tissue to work their way into the muscular lining of the uterus.

Like fibroids, adenomyosis usually causes no symptoms at all. When symptoms appear, they usually include increasing menstrual flow — periods that become both longer and heavier — and increasing menstrual pain, which may become severe. Some women notice pain on intercourse and pelvic pressure before the menstrual period begins.

Adenomyosis, a condition in which the endometrium grows into the wall of the uterus

Adenomyosis, a condition in which the endometrium grows into the wall of the uterus

What is the treatment for adenomyosis?

If you have symptoms that suggest adenomyosis, your doctor will give you a pelvic exam to check your uterus. Sometimes the uterus is enlarged and either hard or soft — different from its usual consistency. To differentiate between a possible pregnancy or fibroids, you may be given a pregnancy test and an ultrasound.

Unfortunately, adenomyosis is difficult to treat. If the symptoms are mild, sometimes nonsteroidal anti-inflammatory drugs take care of the pain. Often adenomyosis will go away by itself after menopause. Hysterectomy is the definitive treatment. If you have have completed your family or do not intend to have one, a hysterectomy need not be a disastrous event.

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