Brief Answer: DETAILS ARE GIVEN BELOW. Detailed Answer: Hello XXXXXXX Thanks for writing to us on Healthcare Magic. Dysmenorrhea (painful menstrual period) is a most common medical condition in reproductive age group women. As your last ultrasound scan is normal, it is suggestive of primary or spasmodic type Dysmenorrhea without any specific organic disease. Other least possible causes could be Pelvic or vaginal infection, Pelvic Inflammatory Disease, Urinary Tract Infection, Using IUCD (if any) etc. Here, you need to undergo some additional investigation like Urine examination- routine & culture, blood sugar, complete blood count, vaginal swab test etc to rule out other possible causes. Proper treatment depends on diagnosis of the case. You may require antibiotic medication for short course after reviewing all reports. Kindly, consult with your gynecologist for proper guidance. Some general guidelines should be followed to get effective result from current condition: 1) Improvement of general health and simple psychotherapy with explanation of the fact and assurance which helps to increase the pain threshold. 2) Bowel should be kept empty. Drink plenty of fluid/ water/ juice. Take healthy diet with more vegetables in small amount at least 6 times. 3) Total avoidance of tea/ coffee/ fast food/ salt from the second half of the cycle (after day 14) till period is over. 4) Try to avoid mental stress, depression or upset by meditation or yoga. Light exercise is also useful in this condition. Maintain genital hygiene properly. 5) If they don’t help much or pain is not controlled, you can take anti spasmodic medicine like combined mefenamic acid and drotaverine 2-3 times daily till pain subsides. Alternate hot and cold compression around back region is also useful. 6) Alternatively, you can take combined oral contraceptive pill (COCP) cyclically from Day1 of each menstrual cycle. In such case, you must consult with doctor for prescription. It is more effective. Hope, this information is quite helpful to you. Let me know, if you need any clarification. Wish your good health and take care yourself. Regards, Dr Soumen For any future query, you can directly ask me by viewing this page WWW.WWWW.WW

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Brief Answer: NEED ADDITIONAL INFORMATION. Detailed Answer: Hello, Thanks for your response. I am trying to solve your problem. In this context, I need some additional information before giving you next line of management of this case. It will help to assist you better. 1) Do you have any abnormal or excessive vaginal discharge in between period? 2) Do you feel any pain during sexual intercourse or other symptoms like fever, nausea, headache etc? 3) Does abdominal pain remain throughout the cycle or just 8 to 10 days during and after period? 4) Is there any particular area of abdominal pain? Is is sharp or dull pain? Waiting for your reply. Kindly, answer the queries at the earliest. Regards, Dr Soumen

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Brief Answer: NEED TO RULE OUT PID. CONSULT WITH YOUR DOCTOR. Detailed Answer: Hello, Thanks for giving additional information. In this context, we need to rule out Pelvic Inflammatory Disease (PID) as you are suffering from lower abdominal pain including vaginal region during and after period (8-10 days) for last 2 years. Herein, some additional investigations are required to confirm the diagnosis. These include: 1) Culture and sensitivity test of vaginal or bartholin gland discharge. 2) Blood test - Complete Blood count, CRP, ESR, Blood Sugar and Hb%. 3) Pelvic examination with or without speculum for cervical motion tenderness. 4) Serological test to eliminate STD like Gonorrhea, Syphilis and Chlamydia etc. 5) Histopathological Examination (under microscope) or biopsy of endometrium tissue to rule out endometritis. 6) Diagnostic Laparoscopy - It is reserved and gold standard test to diagnose PID when abnormal report is found in above tests. MODE OF TREATMENT: 1) Anti-spasmodic or analgesic : Combined Paracetamol and Diclofenac or Ibuprofen is given along with antacid (like Ranitidine etc) to reduce pain. 2) Proper antibiotic regimen: It depends on Culture- Sensitivity and Serological test report. Combined Doxycycline, Azithromycin and Ofloxacin group of medicine are usually preferred. It is given for 1-2 weeks. 3) Hormonal Medication : Low dose Combined OCP has protective role against PID. It also helps to reduce period pain. 4) Precaution : Maintain genital hygiene properly and follow previous preventive measures as mentioned in my earlier text. You must avoid sexual intercourse till treatment is completed or you can practice protected sex with condom. To summarize, you must visit to your doctor for proper guidance of above tests and pelvic examination. Kindly, procure a complete prescription for the same. Hope, I have guided you properly with medical advice. If you don't have any other query you can close the discussion. Good luck. All the best. Regards, Dr Soumen

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