The relationship between dysmenorrhoea and piriformis syndrome

Abstract

Introduction: Dysmenorrhoea is the presence of pain during the menstrual cycle. It is divided into two types: primary and secondary. Primary dysmenorrhoea means painful menses in women with normal pelvic anatomy while the secondary one is the existence of menstrual pain due to an underlying pathology or an abnormality of reproductive system. Prevalence of primary is greater than secondary among adolescents more than older women by about 50– 90%. Many studies have reported the effect of dysmenorrhoea on the muscles associated with the reproductive organs. Moreover, it could be caused by structural faults or by imbalanced piriformis, hip adductors, gluteus medius or gluteus minimus muscles. Piriformis syndrome is one-sided gluteal pain that may or may not radiate into the lower limb. It usually results from sciatic nerve compression by piriformis muscle. It worsens with sitting, passive hip flexion, adduction, internal rotation as well as resistive hip abduction and external rotation. Objectives: To study the correlation between dysmenorrhoea and piriformis syndrome and the link between menstrual pain and status of piriformis muscle during the first day of menstruation. To test clinically the importance of piriformis palpation test for females who complain of gluteal pain during their periods. Materials and methods: This was an observational study on 33 non-married females who were recruited randomly from society, aged between 15– 25 years old and suffering from dysmenorrhoea. Menstrual Distress Questionnaire (T-form), which studies type and intensity of symptoms that women experience before, during or after their menstrual cycles. The McGill Pain Questionnaire (Long Form) was used for assessing candidates on the first day of their menstrual bleeding. In addition, Pace and FAIR (flexion, adduction, internal rotation) manoeuvres as well as the palpation test were all applied bilaterally on the piriformis muscles. Results: The majority of candidates had a positive response to the palpation test (62%). This test was not correlated with menstrual pain (P =0.149) as well as with behavioural changes of dysmenorrhoea (P =0.811). Conclusions: Dysmenorrhoea does not cause piriformis syndrome. However, positive results of piriformis palpation test suggest that dysmenorrhoea may cause spasmodic or tender piriformis muscle, which is an indication of weakness. Acknowledgements: We thank Allah for his kind guidance and support. Special thanks to candidates who participated in the study, our families and friends and our supervisor, Ms Nawal Al-Jumaei.