Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Dysmenorrhea

3,496 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Dysmenorrhea

  1. 1. DYSMENORRHEA By Dr Faisal Al Hadad Consultant of Family Medicine, PSMMC
  2. 2. Dysmenorrhea  Dysmenorrhea is chronic, cyclic pelvic pain associated with menstruation.  Two main categories 1- Primary: painful menstruation without associated pelvic disease 2- Secondary: painful menstruation caused by pelvic pathology
  3. 3. Evaluating patient with dysmenorrhea 1- History 2- Physical examination: should be completely normal in Pt with 1ry dysmenorrhea, however if evaluated during the pain uterus & cx will be mildly tender 3- Investigations: not required if Hx & physical examination are consistent with 1ry dysmenorrhea *U/S *HSG *Laparoscopy allow physician to confirm presence *Hystroscopy or absence of pelvic disease *D&c
  4. 4. Primary dysmenorrhea  Primary dysmenorrhea is the most common gynecologic complaint and one of the leading causes of absenteeism in young women  Increased levels of PG stimulates uterine smooth muscle contraction → vasoconstriction of the uterine arteries → uterine hypoxia → pain of dysmenorrhea  Onset: within 6-12 months after menarche  Usually begins few hrs before or with the onset of menstruation  The pain is crampy/ colicky in the lower abdomen and suprapubic area associated with nausea, vomitting, diarrhea, headache and fatigue.
  5. 5. Treatment of 1ry dysmenorrhea 1- NSAIDs are 1st line treatment *Propionic acid derivatives (Ibuprofen, naproxen) *Fenamates (mefenamic acid) 2- Oral contraceptives * If NSAID are not effective or contraindicated * 90% effective within 3-4 months of use 3- Some Pt may require combining both drugs 4- Consider 2ry dysmenorrhea if no improvement with therapy
  6. 6. Causes of 2ry dysmenorrhea         Endometriosis Adenomyosis Endometrial polyp Fibroid Cx stenosis Pelvic inflammatory disease Presence of an IUD Adhesions
  7. 7. Evaluating pt with 2ry dysmenorrhea 1- History - Onset of symptoms : several years after menarche - Recurrent pelvic infections (PID) - Fever and vaginal discharge (PID) - IUCD - Recent pelvic surgery (adhesions) - Heavy periods (adenomyosis, endometrial polyp, fibroid) - Infertility and dysparunea (endometriosis) 2- Physical examination: may help in Dx by finding abnormalities that point to a pelvic disease
  8. 8. Evaluating pt with 2ry dysmenorrhea 3- Investigations  CBC: anaemia related to chronic menorrhagia, infection (PID)  Cervical/vaginal swabs for cultures: PID  Transvaginal ultrasound: pelvic masses, uterine fibroids and polyps, pelvic abscess, adenomyosis.  Laparoscopy: both diagnostic and therapeutic, particularly in the management of endometriosis and where pain is of uncertain origin  Hysteroscopy: defines intrauterine pathology and provides an endometrial tissue sample for histology
  9. 9. CX STENOSIS  Causes: - Congenital - 2ry to cervical injury (electrocautery, cryocautery, conization, infection)  Presentation: Scanty menstrual flow & sever cramping through out the menstrual cycle  Diagnosis: Internal os scarred & impossible to pass uterine sound or even very thin probe  Treatment - D&C - Vaginal delivery afford more lasting cure
  10. 10. ENDOMETRIOSIS  Endometriosis: an ectopic endometrial tissue in extra-uterine sites (ovaries, fallopian tubes or uterosacral ligaments)  History: Sever dysmenorrhea, infertility and dysparunea  Pelvic examination - Evidence of endometriosis in vagina or cx - Rectovaginal examination reveals tenderness and nodularity along the uterosacral ligaments
  11. 11. ENDOMETRIOSIS  Diagnosis -Laparoscopy or laparotomy -Direct biopsy of vaginal or cx lesion  Treatment - Suppress menstruation (OCP, GnRG agonists, danazol) - Cauterization of endometriotic spots
  12. 12. Pelvic inflammatory disease  PID adhesions  pelvic pain  History - Acute episodes of abdominal pain begins with menses & continues - Fever - Vaginal discharge  Examination - Sever tenderness on palpation of the uterus & cx motion - Purulent cx discharge
  13. 13. Pelvic inflammatory disease  Investigations: ↑WBC, ↑ESR, ↑CRP  Treatment - Appropriate antibiotics - Surgical  release of adhesions
  14. 14. Thank you

×