2. Definition
• Defined as painful menstruation
• Greek name : dys = painful/
meno = monthly/
rhoe = flow
Painful uterine cramps occur : few days prior
during
BUT SUBSIDES AT END OF MENSTRUATION
Menstruation
3. • Commonest disorder affecting females of reproductive age.
• Lead to disruption of day to day activities, school absence, and
limitation on social, academic and sports activities.
• Incidence 50% to 70% and 10% severe.
5. What is primary dysmenorrhea?
• Defined as painful menstruation in the absence of any pelvic
pathology, usually seen in nulliparous young girls.
• Here pain and bleeding associated together
• Pain is cramp and colicky and associated in midline lasts for 12 – 72
hours.
• Start with 6 to 12 moths after menarche
6. • Common in nulliparous females and improve after childbirth.
• Positive family history of dysmenorrhea
9. PG production
increase during first
48 – 72 hours of
menstruation
PROSTAGLANDIN
(PGF 2 alpha)
release from
endometrial cells
Uterine smooth
muscle contract and
cause uterine
ischemia
10. Investigations
1. FBC and CRP to exclude PID
2. High vaginal swab and endocervical swabs to exclude infections
such as Chlamydia Trachomatis and Neisseria Gonorhea
3. CA 125 raised in endometriosis
4. Pelvis USS to exclude uterine anomalies, tuboovarian abcess,
endometrioma
5. Hysteroscopy to diagnose endometrial polyps and submucous
fibroids
6. Laporoscopy to diagnose minimal endomteriosis, pelvic adhesions,
and early PID
11. Management of primary dysmenorrhea
• Medical management divided to
Non hormonal (NSAID) Hormonal
Mefanamic acid
500mg 8hrly
Naproxen sodium
275mg 6hrly
Diclofenac
sodium 75 –
100mg daily
Combined oral
contraceptive pills
Progesterone
containing IUDS
(merina coil)
12. How do these act?
• NSAID inhibit prostaglandin production
13. Side effects of NSAIDS
• Gastric irritation
• Nausea
• GIT ulceration
• Nephrotoxicity
• Headaches, blurred vision
(fenamates) – mefanamic acid and dizziness
• Bronchospasms in asthmatic patients
• Hypersensitivity reaction
15. OCP mechanism of action
• Inhibition of ovulation Inhibition of ovulation
Decrease
prostaglandi
n
Decrease
endometrial
thickness
16. If measures fail (rarely done)
• Cervical dilatation
• Presacral neurectomy, if all other measures fail
Presacral Neurectomy is the surgical removal of the presacral plexus,
the group of nerves that conducts the pain signal from the uterus to
the brain. Indicated for the treatment of central pelvic pain including
severe dysmenorrhea
17. What else may be helpful to improve
dysmenorrhea
• To continue normal activities
• Gentle abdominal massage
• Regular exercise
• Avoid stress,
• Avoid lack of sleep
18.
19. Investigations
1. FBC and CRP to exclude PID
2. High vaginal swab and endocervical swabs to exclude infectons such
as Chlamydia Trachomatis and Neisseria Gonorhea
3. CA 125 raised in endometriosis
4. Pelvis USS to exclude uterine anomalies, tuboovarian abcess,
endometrioma
5. Hysteroscopy to diagnose endometrial polyps and submucous
fibroids
6. Laporoscopy to diagnose minimal endomteriosis, pelvic adhesions,
and early PID
25. Evaluating a patient
• H/O
Older patients with onset of patients
Several years after menarche
Heavy periods / irregular cycles
Examination
Cervical excitation pain in PID
26. Premenstrual syndrome PMS
• A group of physical,emotional, and behavioural symptoms that occur
in 2nd half (luteal phase) of the menstrual cycle
• Often interfere with work and day to day activities, here period of
symptoms entirely free starting with menstruation.
27.
28. symptoms
• Bloated feeling,wt gain, edema
• Breast pain and tenderness
• Hot flushes, headache, nausea
• Pelvic pain, change in bowel habits
• Joint or muscle pain
• Emotionally include irritability, aggression,tension,anxiety,depression,
29. What cause this?
• Not many known theories
• Various hormonal interactions
• Vit b6 deficiency
• Psychological
30. • Ovulation and progesterone production are important in this
syndrome
• And drugs that inhibit ovulation relieves the PMS symptoms
31. management
• Counselling and reassurance that symptom are real and it could be treated
• Lifestyle : exercise dietary modifications
• Exercise 20- 30 mts increase the endorphins in the brain, distract the
women from her emotions
• Medical: symptomatic mx bloating : diuretics
antiprostaglandins : for cramp pains
breast tenderness bromocriptine
ovulation suppression : OCP, danazol,
medroxyprogesterone acetate continuously, primrose oil
32. Bromocriptine (Parlodel) is used to treat symptoms of
hyperprolactinemia (high levels of a natural substance
called prolactin in the body) including lack of menstrual
periods, discharge from the nipples, infertility (difficulty
becoming pregnant) and hypogonadism
33. Danazol reduces estrogen
production and levels, it has
functional antiestrogenic properties.
The combination of its
antiestrogenic, androgenic, and
progestogenic or antiprogestogenic
actions cause atrophy of the
endometrium, which alleviates the
symptoms of endometriosis
