Dysmenorrhea
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Transcript of Dysmenorrhea
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DYSMENORRHEADYSMENORRHEA DYSMENORRHEADYSMENORRHEA
By Dr Faisal Al HadadBy Dr Faisal Al Hadad
Consultant of Family Medicine, PSMMCConsultant of Family Medicine, PSMMC
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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
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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
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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.
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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
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Causes of 2ry dysmenorrhea
Endometriosis Adenomyosis Endometrial polyp Fibroid Cx stenosis Pelvic inflammatory disease Presence of an IUD Adhesions
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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
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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
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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
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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
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ENDOMETRIOSIS
Diagnosis
-Laparoscopy or laparotomy
-Direct biopsy of vaginal or cx lesion
Treatment
- Suppress menstruation (OCP, GnRG agonists, danazol)
- Cauterization of endometriotic spots
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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
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Pelvic inflammatory disease
Investigations: ↑WBC, ↑ESR, ↑CRP
Treatment
- Appropriate antibiotics
- Surgical release of adhesions
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Thank you