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Dysmenorrhea and PMS

Dysmenorrhea and PMS. Nazila Karamy-MD Obstetric and Gynecology Specialist www.doctorkaramy.ir. Primary Dysmenorrhea. Painful menstruation without underlying pathology Commonest in teens(13-19),early twenties

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Dysmenorrhea and PMS

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  1. Dysmenorrhea and PMS Nazila Karamy-MD Obstetric and Gynecology Specialist www.doctorkaramy.ir

  2. Primary Dysmenorrhea • Painful menstruation without underlying pathology • Commonest in teens(13-19),early twenties • Onset 1 or Max 2 years after menarche(cos of it occurs only in ovulation cycle tht it happens 1 year after menarche) If it occurs 2 y after menarch almost always it’s not primary dysmenorhea

  3. Clinical characteristics pain:happaens with mense onset it takes long Max 2-3 days The kind:colic or cramp Location:usually :Midline in suprapubic, sth in back ,flunk,thigh Associated: vomiting and faintness,loss of appetite,diarhea,headache Reduce with increasing age @after NVD

  4. Etiology (primary dysmenorhea) • Decrease of progestrone in the end of luteal phase(near to next mense)=>lysosome rupture => phospholipase A2 + => Increase PG E2,PF2@=>Contraction of uterus ,vasoconstrictor

  5. Secondary Dysmenorrhea • Painful menses secondary to pathology • Onset =>always after 20 y Pain may begin before bleeding and may last for entire duration • Commoner 30s and 40s

  6. Secondary Dysmenorrhea • Endometriosis • Polyp(source=>endometer) • Fibroidce (source=>myometer) Pelvic Inflammatory Disease(PID) • Uterine anomalies(Bicorn uterus,...) • Ovarian cysts @tumors

  7. History Taking so according tht treat • Timing • Severity • Disruption in life-style • Previous gynae history • Contraceptive needs • Wish for fertility

  8. Examination • Vaginal exam not essential in young female with ? Primary dysmenorrhea • Vagina ?septum/ tenderness in BME • Uterus? size / mobility/ position/tenderness • Adnexa ?tenderness/ enlargement

  9. Investigations • Transabdominal ultrasound with full bladder • Transvaginal ultrasound –increased sensitivity • Laparoscopy –gold standard for endometriosis • Risks versus benefits • @U CAN’T FIND ANY PATHOLOGY

  10. Management Primary Spasmodic Dysmenorrhea • Education esp husband • Nutrition:decrease taking sweet ,fatty ,alchohol,coffeine,choclate,salt,red meat • Increase sea food,vegetable,fruit • Exercise:aerobic(Min 30 minutes, 4times/weeks • Calcium supplement=>decrease mood disorders

  11. MEDICAL THERAPY • Prostaglandin synthetase inhibitors(NSAIDS)=>Mefenamic acid or Ibuprofen(Advil) taking regular from first day till 3 days(No need taking before mestural cycle)

  12. Combined oral contraceptive pill-choose a progestagen dominant pill Such as Tricycle” pill • IN RESISTANT CASES: Presacral neurectomy hystrectomy

  13. In Failure to respond to Pill=>> Regard secondary dysmenorhea • increases likelihood of underlying pathology tht treatment is due to the patology

  14. PMS(Premenstrual Syndrome) • Physiological premenstrual change • About 95% of females experience one or more symptom

  15. Symptoms • Physical :bloating/breast tenderness/headache/flushing • Psychological:agression/agitation/crying bouts/depression/irritability

  16. Etiology • PMS exists only in ovulation cycle SO it’s not in menapause ,oophorectomy,non ovulatory cycles • It happens in luteal phase not in follicular phase

  17. Etiology SO Endocrine changes =>decrease endocrine,serotonin in PG metabolism, IN LUTEAL PHASE,change

  18. Treatment • Control nutrition @exercise as dysmenorhea • Psychologic treatment by relaxation or medical therapy if needed • SSRI inhibitors:Floxetin( both continuous ,intermittant are effective) • Nortriptilin in severe deppression)(25 mg /day through the cycle) • Alprazolam in severe anxiety

  19. Bromocriptin in breast congestion (2.5 mg from the Day 10 to 26 of the cycle) In severe breast congestion =>danazole is OK • Spirinolactone in severe weight gain ,edema ,abdomen bloating

  20. If no response to usual Treatment??? • Temporary or permanent abolition of ovulation by: • GnRH analogue plus Add back regimen • OCP,High dose of progestrone (Depo provera 150 mg every 3 months) • Hysterectomy and Oophorectomy if not response to other treatment @not want to be pregnant

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