American Medical Association Family Medical Guide - American Medical Association [567]
Symptoms
Menstrual pain varies considerably. Some women have dull pain in the lower abdomen or lower back; others have severe, cramping pelvic pain. The pain is usually worse at the beginning of the period and may begin 12 to 24 hours before the onset of bleeding. Sometimes the pain is accompanied by nausea, vomiting, and leg cramps.
Diagnosis and Treatment
Your doctor can diagnose dysmenorrhea from your description of the symptoms. Painful periods are very common, but most cases are mild and do not require treatment. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can be effective in relieving menstrual pain. Your doctor may prescribe a stronger NSAID if the over-the-counter medications do not provide relief. Applying a heating pad to your pelvic area may also help. Oral contraceptives can help reduce menstrual cramps.
See your doctor if you develop severe menstrual pain that is not relieved by over-the-counter medications. He or she will examine you to find out what is causing the pain. Sometimes a surgical procedure called laparoscopy is needed to discover the cause of severe pelvic pain.
Heavy Periods
Unusually heavy or prolonged periods are known medically as menorrhagia or hypermenorrhea. Heavy periods are defined as periods that last longer than 7 days or that soak a large sanitary pad in less than 2 hours. A spontaneous disturbance of the hormones that control the menstrual cycle may cause heavy periods. Heavy periods can also result from fibroids (see page 867), small growths in the lining of the uterus called endometrial polyps, or a precancerous buildup of the endometrium, the tissue that lines the uterus (endometrial hyperplasia; see page 868). Endometrial hyperplasia is easily treated but, if not treated, can progress to cancer of the uterus (see page 869). Uterine cancer usually must be treated with a hysterectomy (surgical removal of the uterus; see page 870). Some kinds of IUDs (see page 472) can also cause heavier periods in a small percentage of women.
Some women regularly have heavy periods; others have them only occasionally. The condition frequently occurs in young women who have not yet established a regular ovulation cycle, and is especially common in women approaching menopause. If you regularly have heavy periods and do not consume enough iron-rich foods, you can develop iron deficiency anemia (see page 610).
Diagnosis
If you have a single, unusually heavy period and the bleeding does not diminish within 24 hours, or if you have been having heavy periods for some time, call your doctor. If your period is late as well as heavy, you may be having an early miscarriage. In this case, see your doctor immediately. Your doctor will ask you questions and examine you to find out the extent of bleeding and to see whether there could be an abnormality in your uterus. The doctor may do a Pap smear (see page 140) to check for cancer of the cervix, and an endometrial biopsy (see below) to screen for cancer of the uterus. A blood test will help determine if the heavy bleeding has caused anemia and will identify any other blood or hormone problems that could be contributing to your heavy periods.
Treatment
If you have a single heavy period and do not think you are pregnant, reduce your activity, drink extra fluids, and take an iron supplement. If you have consistently heavy periods and tests do not find the cause, your doctor may prescribe a medication that contains the hormone progesterone (or estrogen combined with progesterone) to reduce the bleeding. These are the same hormones contained in oral contraceptives. Nonsteroidal anti-inflammatory drugs sometimes help reduce the bleeding. If you are using a copper-containing IUD, your doctor may recommend that you consider another method of contraception. If blood tests indicate that you are anemic, you will need to take iron supplements.
Endometrial biopsy
For an endometrial biopsy, the doctor takes