What causes painful menses twice a month despite medicine?

Question

Hello doctor,

I am not sexually active. l have secondary dysmenorrhea, but I am yet to know the underlying condition. So l have my menses twice a month, and l take over-the-counter painkillers, but they usually end up not working. What can l do? I am in a lot of pain, and also, during my menses, l can feel a lump in my vagina. Is it normal? l also have butt cramps and pelvic cramps when I am not menstruating. I was thinking of using contraceptive pills, but I am afraid of using them.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your symptoms sound really distressing, and it is good that you are seeking answers. Let us break everything down so you can better understand what might be going on and how to move forward.

Your key symptoms:

Not sexually active.
Secondary dysmenorrhea (painful periods with a possible underlying cause).
Menses occur twice a month (irregular, possibly heavy, or prolonged bleeding).
OTC (over-the-counter) painkillers are not helping.
Lump in the vagina during menstruation.
Butt or pelvic cramps even outside menstruation.
Considering birth control pills but is hesitant.

What could be causing this?

Since you have secondary dysmenorrhea, we need to rule out common structural causes:

Endometriosis: Very likely based on your severe cramps, pain outside of periods, and butt pain (can be from rectovaginal or pelvic involvement). It can also cause spotting or irregular cycles.
Adenomyosis: Thickening of the uterine wall. It causes heavy, painful periods, often twice a month. It responds well to hormonal treatment.
Fibroids or polyps: Can feel like a lump, especially during menses when tissues swell. It may cause pelvic pressure, heavy bleeding, or irregular cycles.
Ovarian cysts: Sometimes cause irregular bleeding, pressure, or pain.
Pelvic floor dysfunction: This could contribute to butt cramps or vaginal heaviness.

That lump you feel in your vagina:

It could be a prominent vaginal wall vein, cervix felt lower during menses, or prolapse (less common in your age if never pregnant). A pelvic exam or transvaginal scan is needed to be sure.

Why are painkillers not working?

If it is endometriosis or adenomyosis, NSAIDs (non-steroidal anti-inflammatory drugs) alone are often not strong enough. You may need a combined treatment plan, such as hormonal regulation and pain control.

What can you do now?

Get a pelvic ultrasound (preferably transvaginal): To check for fibroids, cysts, adenomyosis, and structural causes. It is non-invasive and gives good insight.
Consider hormonal options: Combined oral contraceptives (COCs) or progestin-only pills can regulate cycles and reduce or eliminate pain and bleeding. You do not need to be sexually active to use them. Modern pills are safe for most women and can significantly improve the quality of life. We can discuss non-pill hormonal options, too.
Track your cycle and pain: Use an application or journal to note when pain starts, duration and bleeding pattern, severity (one to ten scale), and associated symptoms (fatigue, bloating, and mood).
Ask your gynecologist about starting an evaluation for endometriosis. It may include ultrasound, MRI (magnetic resonance imaging), or, eventually, laparoscopy if needed. Early management is key to preventing long-term issues.

I hope this has helped you.

Please feel free to reach out to me again if you have further queries.

Thank you.