Pain and period problems

Pelvic pain

Pelvic pain can be due to many different types of causes including scar tissue, nerve problems, endometriosis and ovarian cysts. It is important that a clear diagnosis is made promptly, in order to offer effective treatment. The investigations required are usually a pelvic ultrasound scan and a laparoscopy (a day-case operation done under general anaesthetic to look at the pelvic organs). Treatment is aimed at dealing with the underlying cause.

Painful periods (the medical term is dysmenorrhoea)

There are two patterns of painful periods. The first type is cramping pain (sometimes called spasmodic) which occurs during the period. This is what many women experience when they start their periods. The second type is a more constant pain (sometimes called congestive), which often occurs before the period starts, and which is relieved by the onset of the period, or continues on through it. This type usually has an underlying cause, such as endometriosis, or pelvic adhesions.

Depending on the history and the examination, a pelvic ultrasound scan will usually be performed, and sometimes, you may be recommended to have a diagnostic laparoscopy, to directly look at the womb, the tubes and the ovaries. In many cases the treatment could be done at the same time of laparoscopy.

Heavy, prolonged or irregular periods

A woman can have heavy regular periods (when it is called menorrhagia) or heavy irregular – usually frequent periods. She may also bleed between the periods or after intercourse.
These could be caused by a number of conditions including hormone imbalance, polyps and fibroids.

Following a careful history and examination, some investigations may be requested, including pelvic ultrasound scan, blood tests (for hormones or anaemia), out-patient biopsy from the lining of the womb, cervical smear, swabs to detect infection or camera examination of the inside of the womb (hysteroscopy). Not all of these are required in every woman. Treatments include tablets to reduce blood loss, hormonal tablets to regulate the period, insertion of a special coil (Mirena) or day-case key-hole operations (such as thermal ablation of the endometrial, where heat is applied to the lining of the womb for a few minutes).

These simple treatments are successful in most women, but when they do not work your consultant will discuss with you the option of removing the womb (hysterectomy) which may be done through an abdominal operation (abdominal hysterectomy) or through the vagina (vaginal hysterectomy).

Painful sex (called dyspareunia)

This is can be either superficial or deep. Superficial pain is caused by vaginal conditions, such as infection. Deep pain can be caused by the problems with the deeper organs in the pelvis such as endometriosis or cysts on the ovary. There are a variety of causes, which need to be checked for, starting with the history and examination, taking vaginal swabs, having a pelvic ultrasound scan, and sometimes a laparoscopy.

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