It may be that you have adenomyosis which is the presence of endometrial glands and supporting tissues in the muscle of the uterus where it normally would not occur. When that gland tissue undergoes growth during the menstrual cycle and then subsequent sloughing, the old tissue and blood cannot get out of the muscle and flow out of the cervix as part of normal menses. This trapping of the blood and tissue causes uterine pain in the form of menstrual cramps. It also produces abnormal uterine bleeding and clots as some of the blood finally escapes the muscle and results in prolonged spotting.

It has been suggested as a possible associated factor in causing adenomyosis is tubal ligation. Under this theory, normal retrograde flow is blocked due to the ligation of the fallopian tubes. This would increase the intrauterine pressure and force some of those cells down into the muscle of the uterus and therefore development of adenomyosis. There is some support for the concept that women who have adenomyosis have more frequently had a tubal ligation.

Age is also a factor as this is seen in women 40 and older after tubal ligation.

It is best to discuss this with your GYN so fibroids can also be ruled out.

I personally had a tubal ligation and fibroids which increased the cramps, bleeding and cramps. I opted for a vaginal hysterectomy when I was 45. (kept my ovaries) Best thing I ever did.

Let me know if you have more questions.

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