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DEFINITION
Dysmenorrhea (or dysmenorrhoea) is a gynecological medical condition of pain during menstruation that interferes with daily activities Greek words Dys meaning painful Meno meaning monthly Rhoe meaning flow
By American Congress of Obstetricians and Gynecologists, retrieved January 2011
EPIDEMIOLOGY
Prevalence: 25% of women. Severe dysmenorrhea: 10 to15% Greatest: late teens and 20s Races: no significant difference Leading cause of recurrent short-term school absence Childbearing
abc
eMedicine > Dysmenorrhea By Andre Holder, Laurel D Edmundson and Mert Erogul. Updated: Dec 31, 2009
CLASSIFICATION
Primary or idiopathic The pain has no obvious organic cause Secondary The pain is due to an underlying condition
Neuropathic Dysregulation
Psychological causes
Ovulatory cycle
sloughing of the endometrium and prostaglandin release with the onset of menstruation
Estrogens
Progesterones
Symptoms
Increased Conc.PGF2alpha
. The Washington Manual Obstetrics and Gynecology Survival Guide. Lippincott Williams
and Wilkins, 2003. ISBN 0-7817-4363-X
Fibroid
Endometrial Polyp
Adenomyosis
IUCD
Cervical Stenosis
ASSOCIATED SYMPTOMS
HISTORY
GYNAECOLOGICAL SYMPTOMS
RELIEVING FACTORS
post coital bleeding, intermenstrual bleeding, vaginal discharge deep dyspareunia Response to NSAIDs and OCP
FAMILY HISTORY
RISK FACTORS
http://www.cks.nhs.uk/dysmenorrhoea/evidence/references#-370595
http://www.cks.nhs.uk/dysmenorrhoea/evidence/references#-370595
Irregular periods possibility of an obstructing malformation bleeding in between periods thick or foul-smelling vaginal discharge of the genital tract
EXAMINATION
Pelvic examination :
To identify any areas of pain and exclude abnormal anatomy or pelvic masses usually unremarkable not usually indicated in young women who are not sexually active
INVESTIGATIONS
LABORATORY INVESTIGATION
Complete blood picture
TREATMENT
Nonpharmacological
Surgical
PHARMACOLOGICAL
1-NSAID 1st line 80% effective Propionic acid derivatives Ibuprofen Naproxen Fenamates Mefenamic acid
2-ORAL CONTRACEPTIVES
90% effective If NSAID are not effective or contraindicated day 5day 21 for 3-6 cycles. Depot medroxyprogesterone acetate Levonorgestrel intrauterine system
FOLLOW UP
Some Patients may require combining both drugs Consider Secondary Dysmenorrhea if no improvement with therapy
NSAIDS
ischemia &
Symptoms
InhibitPGF2alpha production
Marjoribanks, ^ J; Proctor, M, Farquhar, C, Derks, RS (2010 Jan 20). Marjoribanks, Jane. ed. "Nonsteroidal anti-inflammatory drugs for dysmenorrhoea
OCPs
ovulation & change the hormonal status to that of the early proliferative phase
ischemia &
Symptoms
InhibitPGF2alpha
Production & endometrial thickness
Proctor ML, Roberts H, Farquhar CM (2001). Wong, Chooi L. ed. "Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea
DMPA
Suppresses ovulation
Induces endometrial atrophy Decreases menstrual flow and cramping
LN-IUS
Releases progestin locally inside the uterine cavity local effect on the endometrium, which becomes atrophic and inactive. Menstrual blood loss is reduced
Gupta HP, Singh U, Sinha S (2007). "Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device".
TOPICAL HEAT
J Obstet Gynaecol Can 2005;27(12):11171130
DIETARY CHANGES
Reducing Caffeine, Sugar, and Alcohol Herbal treatments: Corydalis, Ginger tea Intake of warm drinks High fat, salty and junk foods Fresh fruits, leafy vegetables and whole grain products
http://women.ygoy.com/2009/11/16/what-is-dysmenorrhea/
SURGICAL OPTIONS
LAPAROSCOPY HYSTERECTOMY PRESACRAL NEURECTOMY LAPAROSCOPIC UTEROSACRAL NERVE ABLATION (LUNA)