What causes abdominal pain before periods for a year?

Question

Hello doctor,

I have been experiencing a lot of abdominal pain for the past 12 months. The pain typically begins about 12 days before my menstrual flow and continues until my period ends. It radiates from the central abdomen toward the sides and lower back. The pain is severe and often requires the use of analgesics for relief. Along with the pain, I sometimes notice a watery vaginal discharge with an unpleasant odor. I also have a history of severe menstrual cramps, which have been consistent over the years.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I am really sorry you are going through this. From the description, your symptoms are significant and concerning. Based on what you have described, there are a few possible causes that should be investigated thoroughly.

Clinical summary of your symptoms:

Pain timeline: Starts 12 days before menstruation and persists until menstruation ends.
Pain character: Severe, radiating from the abdomen to the back and sides.
Associated symptoms: Watery discharge with odor and history of severe menstrual cramps (dysmenorrhea).
Duration: 12 months of persistent cyclic pain.
Medications: Only using analgesics (pain relief), no other treatments tried.
No laboratory tests have been done so far.

Possible conditions to consider:

Endometriosis: Endometrial tissue grows outside the uterus. Causes cyclic pelvic pain, which often starts before menstruation. It can radiate to the back and sides. Associated with chronic cramps, infertility, and bowel or bladder discomfort. Requires pelvic ultrasound or laparoscopy for diagnosis.
Pelvic inflammatory disease (PID): Usually from an untreated infection (like chlamydia or gonorrhea). Causes chronic pelvic pain, abnormal discharge with odor, and sometimes fever. Needs urgent treatment to avoid infertility. Diagnosis requires a pelvic exam, vaginal or cervical swabs, and an ultrasound.
Adenomyosis: The uterine lining grows into the uterine muscle.Causes painful, heavy, and prolonged periods. Often co-exists with endometriosis. Diagnosed with an MRI (magnetic resonance imaging) or transvaginal ultrasound.
Ovarian cyst or mass: Some cysts cause persistent pelvic or back pain. It should be evaluated by ultrasound.
Cervical or vaginal infection: The discharge with odor could indicate bacterial vaginosis, yeast infection, or an STI (sexually transmitted infection). Needs swab tests and appropriate antibiotics or antifungals.

Immediate steps you should take:

See a gynecologist as soon as possible: You need a full pelvic examination and a transvaginal ultrasound as a priority.
Recommended investigations: Pelvic or transvaginal ultrasound (to check for endometriosis, cysts, fibroids, and adenomyosis). Vaginal or cervical swabs (test for infections: STI panel, bacterial vaginosis, and yeast). Pap smear (if not done recently). Blood tests like CRP (C-reactive protein), ESR (erythrocyte sedimentation rate), and CBC (complete blood count) are used to detect signs of infection or inflammation.
Symptom management (temporary relief): While waiting for your appointments or tests, continue analgesics like Ibuprofen (take with food). Consider a hormonal treatment trial (under doctor supervision), like combined oral contraceptives, which may help regulate cycles and reduce endometriosis pain.

When to seek emergency care:

Severe pain with fever.
Foul-smelling discharge with pelvic tenderness.
Sudden worsening of symptoms.
Nausea or vomiting, or difficulty urinating.

I hope this information is helpful.

Please do not hesitate to reach out if you have further questions. I am always here to help with your health concerns.

Thank you.