Symptom Finder - Menstrual Cramps
MENSTRUAL CRAMPS
Visualizing the anatomy of the female reproductive system will give an appropriate differential diagnosis:
Cervix: Cervical stenosis (congenital or acquired), cervical polyp, cervicitis
Uterus: Fibroids, retroverted uterus, adenomyosis
Fallopian tubes: Pelvic inflammatory disease (PID), ectopic pregnancy, endometriosis
Ovary: Ovarian neoplasm (especially functional tumors), ectopic pregnancy, endometriosis, and PID
Physiologic analysis would bring to mind the endocrinologic causes of menstrual cramps such as thyroid or pituitary disorders. Finally, do not forget psychogenic causes in the differential diagnosis.
Approach to the Diagnosis
A thorough pelvic and rectal examination must be performed to rule out secondary causes such as ovarian cyst, uterine fibroids, and ectopic pregnancy. A sonogram and pregnancy test should be performed if there is an adnexal mass, as well as a smear and culture for gonococcus and Chlamydia. A gynecologist should be consulted. If test results are negative, the patient may be tried on oral contraceptives. Diuretics may be used to treat pelvic congestion. Resistant cases may need laparoscopy and ultimately a dilatation and curettage. A psychiatric consult may be necessary.
MENSTRUAL CRAMPS
Visualizing the anatomy of the female reproductive system will give an appropriate differential diagnosis:
Cervix: Cervical stenosis (congenital or acquired), cervical polyp, cervicitis
Uterus: Fibroids, retroverted uterus, adenomyosis
Fallopian tubes: Pelvic inflammatory disease (PID), ectopic pregnancy, endometriosis
Ovary: Ovarian neoplasm (especially functional tumors), ectopic pregnancy, endometriosis, and PID
Physiologic analysis would bring to mind the endocrinologic causes of menstrual cramps such as thyroid or pituitary disorders. Finally, do not forget psychogenic causes in the differential diagnosis.
Approach to the Diagnosis
A thorough pelvic and rectal examination must be performed to rule out secondary causes such as ovarian cyst, uterine fibroids, and ectopic pregnancy. A sonogram and pregnancy test should be performed if there is an adnexal mass, as well as a smear and culture for gonococcus and Chlamydia. A gynecologist should be consulted. If test results are negative, the patient may be tried on oral contraceptives. Diuretics may be used to treat pelvic congestion. Resistant cases may need laparoscopy and ultimately a dilatation and curettage. A psychiatric consult may be necessary.
