Key clinical features | |
Gynecologic (secondary dysmenorrhea) | |
Endometriosis | Endometriosis often presents with menstrual pain that progressively worsens over time. The pain may be cyclic (menses-related) or noncyclic. |
Adenomyosis | Heavy periods. |
Ovarian cysts | Depending on the size, ovarian cysts may cause pelvic pain, constipation, and/or urgency. |
Intrauterine or pelvic adhesions | Associated with a history of PID. |
Silent PID | History consistent with undiagnosed and untreated PID, which can lead to scarring and adhesions, causing chronic pain. |
Congenital anatomic abnormalities
| Congenital malformations that obstruct menstrual flow tend to cause cyclic pain that commences at menarche. This pattern of pain is unlikely to be primary dysmenorrhea because most females are anovulatory for several months to several years after menarche. |
Use of an IUD | For the first 6 months after IUD placement, can have cramping with bleeding. Check for strings to exclude the possibility that the IUD has been expelled. |
Nongynecologic | |
Inflammatory bowel disease | History of bloody diarrhea or watery stools, often with attenuated growth, weight loss, or fever. |
Irritable bowel syndrome | History of intermittent abdominal pain with constipation and diarrhea; weight loss is unusual. |
Psychogenic disorders | Pelvic pain with a normal examination and negative review of systems, especially if the pain is associated with mood symptoms and psychosocial stressors. |
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