How do you define pelvic pain with menstruation in absence of pelvic disease?

Yes, pelvic pain along with cramps are often associated
with menstrual periods. This type of pain can occur at different stages of the period.
It may also occur due to irregular or missed
menstruation.

At the time of menses,
hormone levels fall and uterine skin lining (endometrium) sloughs. This produces bloody
menstrual tissue called menses as long as the tissue can exit the body. If there is any
blockage to egress, pain is the result. Several different conditions can block menstrual
egress and thus result in painful
menses:

• primary dysmenorrhea (menstrual cramps)
  - the cervical opening is not large enough for the volume of menstrual tissue in a given
  unit of time so uterine pressure builds up producing cramps until the tissue gradually
  comes out


• cervical stenosis - in this case the cervical
  opening has some scarring due to past procedures (LEEP, cryosurgery, conization) rather
  than just a tightly contracted cervix found in primary
  dysmenorrhea


• congenital anomalies of the reproductive
  tract - any anomaly that blocks outflow of
  menses


• endometriosis - endometrial tissue has implanted
  in the peritoneal/abdominal cavity and when the tissue is sloughed at the end of the
  month it has no place to go so it just stays and irritates the pelvic lining producing
  pain.


• adenomyosis - instead of endometrial tissue being
  in the pelvic cavity, little islands of glands have grown down into the uterine muscle
  and like endometriosis, when the tissue is sloughed, it has nowhere to go and only
  produces an inflammatory
  response.

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