Dysmenorrhea (painful period)
Dysmenorrhea
Define dysmenorrhoea : Painful menstruation of sufficient magnitude which incapacitate day to day activities is called dysmenorrhoea.
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Common cause of dysmenorrhea
Primary dysmenorrhea
Secondary dysmenorrhoea
Investigation of dysmenorrhea
Treatment of dysmenorrhea
Common cause of dysmenorrhea :
- Pelvic endometriosis.
- PID : acute or chronic
- Adenomyosis
- Fibroid uterus
- IUCD in situ
Classification of dysmenorrhea :
There are two types of dysmenorrhea :
- Primary dysmenorrhea
- Secondary dysmenorrhea
Primary dysmenorrhea :
Define : The primary dysmenorrhoea is one where there is no identifiable pelvic pathology.
Cause of Primary dysmenorrhea :
- Behavioral and psychological factors :
- Tension and anxiety during adolescence
- Lower pain threshold
- Unhappiness at home or at work.
- Fear or loss of employment.
- Anxiety over examinations.
2. Muscular incoordination and uterine hyperactivity
3. Hormonal imbalances and excessive prostaglandin
4. Other factors :
- Higher circulating vasopressin
- Platelet activating factors (PAF)
Clinical features of primary dysmenorrhea :
- Pain :
- Site : Pain is felt in the hypogastrium
- Onset : Few hours before and after the onset of menstruation
- Duration : Usually lasts for few hours, rarely, lasts longer then 12 hours.
- Character : Spasmodic and colicky in nature.
- Radiation : Inner and front aspects of the thigh
- Relief : When flow is properly established.
2. Systemic discomfort :
Investigation of dysmenorrhea :
- USG is very useful.
Treatment of dysmenorrhea :
A. General treatment :
- Correction of unfavorable environmental factors, malnutrition, general ill health
- Regular physical exercise
- Reassurance
- Usual activities should be continued.
- Analgesics : Aspirin , Paracetamol
- Antispasmodics : Hyoscine butyl bromide
- Newer NSAIDS :
- Indometacin 250 mg tds.
- . Ibuprofen 400 mg tds
B. Hormonal therapy :
- Combined oral pill is taken nightly on each of the 5th to 25th days of the cycle continued for 6 months.
C. Surgical treatment : It is considered when the pain is proven to be truly spasmodic incapacitating medical treatments fails.
- Dilatation of the cervix.
- Presacral neurectomy
- Bllateral block of the pelvis plexus
- Hysterectomy.
- Treatment of retroversion if present.
Secondary dysmenorrhea :
Define : Menstruation- associated pain occurring in the presence of pelvic pathology is called secondary dysmenorrhoea.
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