Medical Health Encyclopedia

Primary Dysmenorrhea. Primary dysmenorrhea is recurrent pelvic pain associated with menstruation whose cause is unknown. Dysmenorrhea is common in many women.

Adenomyosis. A condition called adenomyosis occurs when nodules (knots) of endometrial tissue develop within the deep muscle layers of the uterus. This disorder is often classified with endometriosis, but it actually is a difference disease. (Endometriosis occurs when endometrial tissue grows and functions outside the uterus.) Adenomyosis is a significant cause of severe pelvic pain and menstrual irregularities. Until recently this was only diagnosed after a hysterectomy, but advanced imaging techniques using ultrasound and magnetic resonance imaging scans may be able to detect it.

It typically occurs women who have uterine fibroids and in women between the ages of 40 and 50, and who have had children.

Fibroid tumors may not need to be removed if they are not causing pain, bleeding excessively, or growing rapidly.

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There is some evidence that newer IUDs called levonorgestrel-releasing intrauterine systems (LNG-IUS) may be useful in treating them. A procedure called uterine artery embolization may also be helpful.

Other Causes of Pelvic Pain. Many conditions cause pelvic pain that may or may not be related to menstruation (called dysmenorrhea). Some causes of pelvic pain can be serious and should be ruled out.

Conditions other than endometriosis that cause dysmenorrhea include the following:

• Uterine fibroids
• Pelvic inflammatory disease (which is a result of infections in the pelvic area)
• Miscarriage
• Ectopic pregnancy

Click the icon to see an image of an ectopic pregnancy.

• Pelvic cancer (rare)
• Uterine polyps
• The use of an intrauterine device (IUD) for contraception

Conditions that may mimic symptoms of endometriosis but which are unrelated to problems in the reproductive organs include the following:

• Severe kidney or urinary tract infections
• Celiac disease
• Appendicitis
• Interstitial cystitis
• Inflammatory bowel disease
• Diverticulitis
• Irritable bowel syndrome

Physical Examination