Pain with menses caused by demonstrable pathology.
Endometriosis is a common cause of dysmenorrhea; adenomyosis may also cause it. A few women have an extremely tight cervical os (secondary to conization, cryocautery, or thermocautery); pain occurs when the uterus attempts to expel tissue through the os. A pedunculated submucosal fibroid or an endometrial polyp extruding from the uterus occasionally causes cramping pain. Pelvic inflammatory disease may cause diffuse continuous low abdominal pain that tends to increase with menses. Sometimes, a cause cannot be found.
The first line of treatment is medical (eg, prostaglandin synthetase inhibitors, oral contraceptives, danazol, progestins). If possible, the underlying disorder or anatomic abnormality is corrected, thus relieving symptoms. Dilation of a narrow cervical os may give 3 to 6 mo of relief (and allows diagnostic curettage if needed). Myomectomy, polypectomy, or dilation and curettage may be needed. Interruption of uterine nerves by presacral neurectomy and division of the sacrouterine ligaments may help selected patients. Hypnosis may be useful.
Revision date: June 11, 2011
Last revised: by Sebastian Scheller, MD, ScD