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DYSMENORRHEA

DYSMENORRHEA. AHMED ABDULWAHAB CONSULTANT ASSISTANT PROFESSOR. Classification. Primary dysmenorrhea . Occurs during ovulatory cycles, and usually 6 to 12 month after menarche. Etiology.

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DYSMENORRHEA

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  1. DYSMENORRHEA AHMED ABDULWAHAB CONSULTANT ASSISTANT PROFESSOR

  2. Classification. • Primary dysmenorrhea . • Occurs during ovulatory cycles, and usually 6 to 12 month after menarche. • Etiology. • Uterine contractions with ischemia and increase contractility, and resting tone due to prostaglandin production. • There is associated symptoms like nausea vomiting and headache.Unovulatory cycle contain little PGs and hence painless.

  3. Clinical features • Cramping pain usually begin few hours before the cycle and may persist for hours or days . • It is localized in the lower abdomen and may radiate to the thigh and lower back • May be associated with altered bowel habits , nausea ,fatigue , dizziness, and headache .

  4. treatment • NSAIDs are highly effective , ibuprofen and mefenamic acidmay cause GIT disturbance . • Other class the cyclo-oxygenase inhibitor that have little effect on GIT. • Oral contraceptive pills by inhibiting ovulation . • Progestins . • Tocolytic.

  5. Secondary dysmenorrhea. • It is secondary to an underlying cause and PGs may play a role . • Clinical features . • Generally the pain is not limited to the menses and can occur before as well as after the menses . • It develops in older women and usually associated with other symptoms like dyspareunia , infertility and abnormal uterine bleeding .

  6. Causes . • 1-Endometriosis . • Pain in pre and postmenstrual phase ,there is deep dyspareunia and tender pelvic examination . • Pelvic inflammation , like endometriosis initially pain may be menstrual and often extend into the premenstrual phase with each cycle, may have inter menstrual bleeding .

  7. 2-Fibroid and adenomyosis. • There is dull dragging sensation , uterus is clinically enlarged and may be tender. • 3-Ovarian cysts . • Should be clinically evident. • 4-Pelvic congestion . • There is dull ill-defined pelvic ache , usually worse pre-menstrually and relived by menses .

  8. Treatment . • Treatment of the underlying disease . • The treatment used for the primary dysmenorrhea are often helpful .

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