Chronic pelvic pain is associated with as many as 10% of hysterectomies but its cause is uncertain. Some studies suggest that there may be a link between this type of pain and psychological factors or a history of childhood sexual abuse. Investigation of the underlying cause usually entails a pelvic examination, laparoscopy, and ultrasound or magnetic resonance imaging (MRI) investigations. These can help rule out the presence of fibroids, endometriosis, adenomyosis, disorders of the ovaries and Fallopian tubes, and pelvic inflammatory disease. When no cause is identified for the pain, medical treatments such as nonsteroidal anti-inflammatory agents and the contraceptive Pill are often tried, with hysterectomy being the last resort when pain is so severe that it is disrupting everyday activities and seriously diminishing quality of life.
There are two main types of period pain or dysmenorrhoea (pronounced dis-men-or-eea). Primary dysmenorrhoea usually affects young women who have never been pregnant. It begins when bleeding starts or just beforehand and rarely lasts more than twenty-four hours. The pain is cramp-like and is usually felt in the lower abdomen, lower back or the insides of the thighs. Occasionally it is so severe that it causes fainting, nausea or vomiting. The cause of the pain is linked to an increase in contraction of the uterus. This may be related to excessive secretions of prostaglandin substances by the endometrium or an increased sensitivity of the uterus to them, causing stronger contractions. Secondary dysmenorrhoea is more often experienced by women whose periods have been painless for some years. The pain may last throughout the menstrual bleeding phase and is thought to be a symptom of something amiss in the reproductive system, for example tissue inflammation, endometriosis, pelvic infection or fibroids. Drugs with anti-prostaglandin activity are often used to treat dysmenorrhoea; in severe cases of primary dysmenorrhoea the pain can be stopped by the inhibition of ovulation through hormone treatments such as the contraceptive Pill.
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