Chronic Pelvic Pain

The other day, AG, a 28-year-old accountant, came to see me about her menstrual

cramps. She has been suffering from it since puberty.

“ I had my first period at 12. The pain wasn’t too bad, and it was relieved

after a hot shower. But by my late teens, it was getting more severe and I had to

take Panadol regularly,” she recalled.

When she was in university, Panadol and other pain killers were not

effective anymore. Her family physician suggested oral contraceptives pills.

“My mum was not convinced so she took me to her gynaecologist. I was

just 20.I remember the gynae saying that I had primary dysmenorrhoea and that it

would disappear after I had given birth,” she continued.

“Do you have the pain on the first day or throughout your period,” I

interrupted, as primary dysmenorrhoea refers to menstrual cramps which occur

only on the first day and usually last for a few hours.

“I cannot recall,” she replied.

“Anyway, I was prescribed oral pills. I took them for a few months but

stopped because of the side effects. The cramps became worse and I was

completely incapacitated. On one occasion, I almost passed out.”

“Any investigation done?” I asked.

“Yes. An ultrasound scan and the result was normal. The gynae then

suggested an operation where a telescope was inserted through my belly button to

check my womb (laparoscopy). I reluctantly agreed as the pain was getting