Dysmenorrhea refers to painful periods and is divided into primary and secondary categories. Primary dysmenorrhea involves painful cramps without an identifiable medical cause, while secondary dysmenorrhea is due to conditions like endometriosis. Prostaglandins released during menstruation cause uterine contractions and pain. Symptoms include lower abdominal pain that may radiate to the back or thighs. Treatment focuses on pain relief using NSAIDs, oral contraceptives, heat therapy, and lifestyle changes. For secondary dysmenorrhea, treating the underlying condition is also important.

2. Dysmenorrhea
 It is painful periods, or menstrual cramps, is pain
during menstruation.
 Dysmenorrhea is a term describing painful
menstruation that typically involves cramps caused
by uterine contractions.

3. Categories
 Dysmenorrhea is divided into two categories:
 1. Primary dysmenorrhea
 2. Secondary dysmenorrhea
 Primary dysmenorrhea is: Painful menstruation with
no identifiable pelvic pathology.
 Note: The highest level is in the first 2 days of
menses.
 Secondary dysmenorrhea is: painful menstruation
due to pelvic or uterine pathology.

4. Causes
 Primary dysmenorrhea causes are
 increased prostaglandin production by the
endometrium in an ovulatory cycle which cause
contraction of the uterus.

5. Causes
 Secondary dysmenorrhoea causes are:
 Endometriosis
 Adenomyosis
 Pelvic infection
 Uterine fibroids
 Intrauterine device
 Congenital uterine or vaginal anomaly.

6. Pathophysiology( Primary)
Release of
prostoglandins
Uterine
contractions
Pain and other
clinical
manifestations

7. Clinical Manifestations
 pain in the lower abdomen. (common)
 pain may radiate to the lower back to the thighs.
(common)
 pain may be sharp pelvic cramps or deep and dull
ache. (common)

8. Primary Dysmenorrhoea
 Primary dysmenorrhea starts from 12 to 24 hours
before the onset of menses.
 Abdominal pain often accompanied by:
 • Nausea
 • Diarrhea
 • Fatigue
 • Lightheadedness or headache or dizziness.

9. Cont.

10. Secondary Dysmenorrhoea
 Secondary Dysmenorrhea usually occurs after the
woman has experienced problem free periods for
sometime.
 Pain may be unilateral, constant and continuous,
 longer than primary Dysmenorrhea.
 May be :
 • painful Intercourse
 • painful defecation
 • or irregular bleeding may occur at times other than
menses.

11. Diagnostic Evaluation
 History collection
 Physical examination
 Primary Dysmenorrhea
 cramping pain with menstruation and the physical
examination is completely normal.
 If the signs and symptoms are findings then further
diagnostic evaluation are done…
 Laboratory tests for: CBC R/o evidence of infection. Urine
analysis to R/o bladder infection.
 Cervical culture to exclude STI.
 ESR (Electrolyte sedimentation rate) to detect an
inflammatory process.

12. Cont..
 Non invasive diagnostic procedure.
 Abdominal and transvaginal ultrasound.
 Invasive diagnostic procedure:
 Laparoscopic examination.
 Hysteroscopy and D & C
(dilation & curettage )

13. Treatment
 pain relief :
 NSAIDs, e.g. Naproxen, Ibuprofen.
 low doses of oral contraceptive pills.
 heat application :
 Heat is applied to the lower abdomen or back
may reduce Dysmenorrhea.


14. Cont..
 life style changes like daily exercises.
 wt. loss
 smoking cessation
 relaxation techniques : sleep and rest for adequate
time.
 avoid unnecessary work load.
Management of secondary Dysmenorrhea
 is directed at diagnosis and treatment of underlying
cause ( e.g. endometriosis or pelvic inflammatory
disease i.e. PID.

15. Nursing Diagnosis
 Acute pain related to menstrual cramps
 Fatigue related to blood loss / pain
 Imbalanced Nutrition, less than the body
requirement, related to nausea
 Deficient knowledge related to treatment regimen
 Fear related to disease process

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