Pain during periods is very common and is called as Dysmenorrhoea or simply as menstrual pain. Menstrual pain can be sharp, dull or shooting pain. They also cause nausea and if very severe may force the patient to take leave from work. It may precede menstruation by several days or a few hours or may accompany it, it usually subsides as the bleeding decreases. When the pain is related to an underlying disease or disorder, it is called as secondary dysmenorrhoea.
The common causes of secondary dysmenorrhoea are endometriosis, uterine fibroids and sexually transmitted diseases.
Endometriosis is said to occur in families. 8% daughters of affected mothers, 6% of siblings of affected sisters, 7% of cousins and first degree relatives are said to be affected. 30-40% of patients with endometriosis are infertile which is times the rate of general population.
The symptoms of endometriosis may be highly variable from one patient to another. The magnitude of the symptoms may not correlate with the extent of the disease. The common symptoms are pelvic pain and infertility. Pelvic pain usually occurs during or just before menstruation and lessens after menstruation. Some women experience pain during sexual intercourse, bowel movements or urination. Patients can also have bleeding when they pass urine or stools. Endometriosis can one of the reasons for infertility in otherwise healthy couples.
Endometriosis has been reported only in the reproductive ages, which means right after the start of the menstrual cycle until menopause or immediate post menopausal years. While most cases of endometriosis are diagnosed in women aged around 25-35 years, endometriosis has been reported in girls as young as 11 years of age. Endometriosis is rare in postmenopausal women. Endometriosis can be treated medically or surgically.
Medical treatment includes pain relief modifications or medications to interrupt the periods. Surgical treatment involves laparoscopy which is a key-hole surgery performed under general anesthesia where a small telescope is inserted into the abdomen through a cut in the belly button to clear the endometriosis. The goals of endometriosis treatment may include pain relief and/or enhancement of fertility.
In moderate to severe cases, scarring or adhesions in the pelvis may cause infertility. The fallopian tubes and ovaries may adhere to the lining of the pelvis or to each other, restricting their movement. The scarring and adhesions that takes place with endometriosis may mean that the ovaries and fallopian tubes are not in the right position, so the transfer of the eff to the fallopian tubes cannot take place. Similarly, endometriosis can cause damage and/or blockage to the inside of the fallopian tube, impeding the journey of the egg down the fallopian tube to the uterus.
In vitro fertilization (IVF) procedures are effective in improving fertility for some women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman’s uterus. Pregnancy rate with IVF procedure following a certain protocol of treatment can reach upto 50-60%.