Dysmenorrhea

Every month with my menstruation I get really sick.  Usually it starts with horrible stomach cramps that even if I'm sleep wake me up.  I feel nauseous, I start sweating, I have diarrhea.  When I have an episode my face turns white and I feel like i'll fall to the floor.  Usually I stay in the floor to the bathroom until i feel better because I'll have to use the toilet many times and I'm in so much pain that's hard for me to stand up.  I completely blacked out twice when I was having these episodes.  The worst part usually lasts 30 minutes which sounds short but it's an eternity to me.  After the diarrhea and the vomit stops I still have cramps for maybe 1 or 2 days.  I'm 29 years old and I've having these since I'm 13, I'm so tired of it.  I took oral contraceptives for 2 years and they helped me a lot.  However, since I also take carbamazepine for partial complex seizures, they just discontinued Ovrall and I'm not taking any contraceptive.  I don't know what to do.  I had an episode today and it was really bad.  My gynecologist once said it could be endometriosis but I had a transvaginal ecography and it was normal.

[Elaine Brown, MD]

Hi!
Your symptoms do sound like endometriosis, which, by the way, is not ruled out by the ultrasound.  Usually the first line of treatment for dysmenorrhea is nonsteroidal anti-inflammatories such as Aleve.  If you are going to use these, do it immediately upon the first hint of a symptom and then continue them round the clock for 3-4 days.  The next step up on the treatment ladder is oral contraceptives.  I'm certain that you would be able to obtain a substitute for Ovral -- such as Ortho Novum 1/50 or many others. Next up would be a GnRH agonist such as Lupron.  These are pricey, but can work wonders.  Finally, laser is a great tool for treating endometriosis, and laparoscopy/laser is commonly used for diagnosis and therapy both.
Hope this helps!
Dr B