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I think my menstrual cramps are something out of the ordinary. I'm thirty-one, the mother of a nine-year-old son, and I've had an IUD for five years. The pain that I get during my menstruation is new to me. I didn't have it before the and I think the IUD might have something to do with it. My doctor doesn't want to give me birth control pills because I have fibroid tumors and he is concerned that the pill will make the tumors spread and grow. So I continue to use the IUD but I'm afraid that it's not staying in place. I have these fears of it going up into my uterus. The other night I had a dream about it. I need to know what's causing my pain.

—G.D.

Detroit, Michigan

When a woman has menstrual cramps, it is always important for a physician to evaluate her condition carefully to rule out the possibility of infection from a poorly-placed IUD, troublesome fibroid tumors, or any other serious pelvic disorders, before he decides that the problem is primary dysmenorrhea.

Infection from an IUD will tend to spread even after menstruation, so if a woman continues to have pain and cramping after her period is over, she may have an infection in her Fallopian tube where it could eventually lead to infertility. A doctor can tell if an IUD is well placed by using X-rays or ultrasonography, the sound-wave technique. If he suspects infection in the uterus or Fallopian tubes, he must then take a culture and treat the infection with antibiotics. If a woman has been assured that there is no infection and she continues to have cramping, Motrin, Anaprox, or Ponstel, the prostaglandin-blocking medications, might give her relief. A recent study from Oxford University in England has shown that these drugs not only decrease cramps but also lessen the amount of uterine bleeding.

Her fibroid tumors may be causing the pain due to the decrease in their blood supply during menstruation. On the other hand, if bleeding becomes heavier than normal, a fibroid might have grown and broken through the wall of the uterine cavity, disturbing the uterine lining, which will bleed. Fibroids that are causing considerable discomfort and pain can be removed with an operation called a myomectomy, in which the surgeon can leave the uterus intact but take away the tumors. (Myomectomy is more fully described in Chapter Sixteen.)

Fibroids that are painful can be removed, and an IUD that persistently worries a woman can be taken out. Always, however, a woman must make sure that her doctor has carefully evaluated her case before he decides to make any medical moves. Cramps can be a sign of many different types of pelvic problems. If a woman has tremendous pain before menstruation, she may have pelvic endometriosis, the so-called career woman's disease that is discussed in Chapter Seven. A woman must gauge her body by herself, by understanding how it works. If the woman who wrote this letter is listening to her body and she feels the IUD is at fault, she may very well be right. She must ask her doctor for an evaluation and an explanation of her condition.

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Women's Health