This document discusses dysmenorrhea (painful menstruation) and pelvic pain. It describes primary dysmenorrhea, which occurs in younger women due to uterine contractions and prostaglandins, and secondary dysmenorrhea, which has underlying causes like endometriosis. Treatment depends on the type but can include NSAIDs, hormonal therapy, or surgery. Pelvic pain is categorized as acute or chronic, with chronic pelvic pain affecting 15-20% of women and having potential gynecological or non-gynecological causes. Diagnosis involves a thorough history and physical exam followed by testing, while management typically requires a multidisciplinary team approach.

1. DYSMENORRHOEA AND
PELVIC PAIN
Dr.Tarig Mahmoud
MD SUDAN
HAIL UNIVERSITY KSA

2.  Dysmenorrhoea is defined as painful
menstruation.
 It is experienced by 45–95 per cent of
women of reproductive age.

3. DYSMENORRHEA
 Primary[no underline disease]
 Secondary [secondary to pelvic disease]

4. PRIMARY DYSMENORRHEA
 Description: Pain associated with
ovulatory menses that usually start at or
just before the onsets of menses; and
last 1-3 days.
 Age group: 17-22 years.
 Etiology : due to uterine contraction with
ischemia and prostaglandin production.
 Symptoms: Crampy lower abdominal
pain; +/- nausea, emesis, diarrhea or
headache.
 normal physical examination.

5. TREATMENT
 Reassurance
 NSAIDS
 Hormonal Therapy (OCPs, progestagins,
Mirena IUD, Depo-Provera
 GnRH analogues
 acupuncture
 psychothearpy
 transcutaneous nerve stimulation

6. SECONDRY DYSMENORRHEA
Pathophysiology:
 depends on the underling secondary
cause
 Clinical feature
 Develop in older women.
 Can occur days before and after the
menses.
 Associated with dyspareunia, infertility
and abnormal uterine bleeding.

7.  Causes :
 Endometriosis
 Pelvic inflammation
 Adenomyosis
 cervical stenosis and haematometra (rare).
 Fibroid
 Ovarian congestion
 Ovarian cyst
 Treatment :
 Depend on the causes.

8. PELVIC PAIN

9. Can be:
 Acute pelvic pain
 Chronic pelvic pain

10.  The initial approach to the patient
with pelvic pain should include a
detailed history and physical
examination

11. The history should include
 characterize the pain [location, duration
(constant or intermittent),onset, radiation,
associated symptoms, severity sharp pains,
cramping, dull aching pain.
 alleviating and aggravating factors.
 system symptoms (eg, urinary,
gastrointestinal, and musculoskeletal) to
exclude non gynecological causes.

12. Examination
 abdominal examination
 pelvic examination
Performance of a pelvic examination is the
standard of care for women with lower
abdominal and pelvic symptoms

14. ACUTE PELVIC PAIN
 Pain of sudden onset
 Gynecological causes
 Non Gynecological causes

15. GYNECOLOGIC CAUSES OF ACUTE PELVIC PAIN
 Adnexal accidents[ torsion, Ruptured,
heamorrage].
 Pelvic inflammatory disease.
 Ectopic pregnancy, abortion.

16. NONGYNECOLOGIC CAUSES OF ACUTE
PELVIC PAIN
 Appendicitis ,Diverticulitis.
 Bowel obstruction.
 Adhesions.
 Hernia.
 Urinary tract infection.
 Urolithiasis.
 Pelvic thrombophlebitis.

17. CHRONIC PELVIC PAIN
Definition
Is pelvic pain for more than 6 month and
affect the quality of life.

18.  Difficult to diagnose.
 Difficult to treat.
 Associated great medical costs.

19. Incidence
 Common complain
 Affects 15-20% of women of reproductive age

20. GYNAECOLOGICAL CAUSES
 endometriosis, adhesions .
 fibroids, adenomyosis, endometritis.
 Pelvic congestion syndrome.
 PID/salpingitis, hydrosalpinx.
 IUD/infection.
 severe prolapse.

21. NON- GYNAECOLOGICAL CAUSES
 Urologic
UTI/urethritis, interstitial cystitis (IC), urine
retenion, urethral diverticulum, nephrolithiasis,
malignancy.
 GIT
constipation, IBS, Crohn’s disease, bowel
obstruction, diverticulitis, malignancy.
 Musculoskeletal
myalgia of pelvic floor, hernias, neuralgia, low
back pain.
 Other
psychiatric – depression, ; abdominal cutaneous
nerve entrapment in surgical scar.

22. DIAGNOSIS
Obtaining a
COMPLETE and DETAILED HISTORY
is the most important key to
formulating a diagnosis

23. HISTORY OF CHRONIC PELVIC PAIN
1.Duration of Pain
2.Nature of the Pain
 Sharp, stabbing,
throbbing, aching,
dull?
3.Specific Location of Pain
 Associated with
radiation to other
areas?
4.Modifying Factors
 Things that make
worse or better?
5.Timing of the Pain
 Intermittent or
constant?
 Temporal relationship
with menses?
 Temporal relationship
with intercourse?
 Predictable or
spontaneous onset?
6.Detailed medical and
surgical history
 Specifically
abdominal, pelvic,
back surgery

24. DIAGNOSIS: OBJECTIVE EVALUATIVE TOOLS
 Gonorrhea and
Chlamydia
 Urinalysis
 Urine Culture
 Pregnancy Test
 CBC with Differential
 ESR
 PELVIC ULTRASOUND
 MRI or CT Scan
 Endometrial Biopsy
 Laparoscopy
 Referral to Specialist
Basic Testing Specialized Testing

25. MANAGEMENT
 A team management
 Multidisciplinary team pain clinic [
gynecologist , psychologist expert in
pelvic pain , sexual & marital counseling
, physical therapist with pelvic floor
expertise .

26. CONCLUSIONS
 Chronic Pelvic Pain requires patience,
understanding and collaboration from both
patient and physician
 Obtaining a thorough history is key to
accurate diagnosis and effective treatment
 Diagnosis is often multifactorial – may affect
more than one pelvic organ
 Treatment options often multifactorial –
medical, surgical, physical therapy and
cognitive.

27. Thank you