DYSMENORRHEADYSMENORRHEA

AHMED ABDULWAHABAHMED ABDULWAHAB

CONSULTANTCONSULTANT

ASSISTANT PROFESSORASSISTANT PROFESSOR

Classification.Classification. Primary dysmenorrhea .Primary dysmenorrhea . Occurs during ovulatory cycles, and Occurs during ovulatory cycles, and

usually 6 to 12 month after menarche.usually 6 to 12 month after menarche. Etiology.Etiology. Uterine contractions with ischemia and Uterine contractions with ischemia and

increase contractility, and resting tone due increase contractility, and resting tone due to prostaglandin production.to prostaglandin production.

There is associated symptoms like nausea There is associated symptoms like nausea vomiting and headache.vomiting and headache. Unovulatory cycle Unovulatory cycle contain little PGs and hence painless.contain little PGs and hence painless.

Clinical features Clinical features Cramping pain usually begin few hours Cramping pain usually begin few hours

before the cycle and may persist for hours before the cycle and may persist for hours or days .or days .

It is localized in the lower abdomen and It is localized in the lower abdomen and may radiate to the thigh and lower backmay radiate to the thigh and lower back

May be associated with altered bowel May be associated with altered bowel habits , nausea ,fatigue , dizziness, and habits , nausea ,fatigue , dizziness, and headache .headache .

treatmenttreatment NSAIDs are highly effective , ibuprofen NSAIDs are highly effective , ibuprofen

and mefenamic acidand mefenamic acid may cause GIT may cause GIT disturbance .disturbance .

Other class the cyclo-oxygenase inhibitor Other class the cyclo-oxygenase inhibitor that have little effect on GIT.that have little effect on GIT.

Oral contraceptive pills by inhibiting Oral contraceptive pills by inhibiting ovulation .ovulation .

Progestins .Progestins . Tocolytic. Tocolytic.

Secondary dysmenorrhea.Secondary dysmenorrhea. It is secondary to an underlying cause and It is secondary to an underlying cause and

PGs may play a role .PGs may play a role . Clinical features .Clinical features . Generally the pain is not limited to the Generally the pain is not limited to the

menses and can occur before as well as menses and can occur before as well as after the menses .after the menses .

It develops in older women and usually It develops in older women and usually associated with other symptoms like associated with other symptoms like dyspareunia , infertility and abnormal dyspareunia , infertility and abnormal uterine bleeding .uterine bleeding .

Causes .Causes . 1-Endometriosis .1-Endometriosis . Pain in pre and postmenstrual Pain in pre and postmenstrual

phase ,there is deep dyspareunia and phase ,there is deep dyspareunia and tender pelvic examination .tender pelvic examination .

Pelvic inflammation , like endometriosis Pelvic inflammation , like endometriosis initially pain may be menstrual and often initially pain may be menstrual and often extend into the premenstrual phase with extend into the premenstrual phase with each cycle, may have inter menstrual each cycle, may have inter menstrual bleeding . bleeding .

2-Fibroid and adenomyosis.2-Fibroid and adenomyosis. There is dull dragging sensation , uterus is There is dull dragging sensation , uterus is

clinically enlarged and may be tender.clinically enlarged and may be tender. 3-Ovarian cysts .3-Ovarian cysts . Should be clinically evident.Should be clinically evident. 4-Pelvic congestion .4-Pelvic congestion . There is dull ill-defined pelvic ache , There is dull ill-defined pelvic ache ,

usually worse pre-menstrually and relived usually worse pre-menstrually and relived by menses .by menses .

Treatment .Treatment . Treatment of the underlying disease .Treatment of the underlying disease . The treatment used for the primary The treatment used for the primary

dysmenorrhea are often helpful .dysmenorrhea are often helpful .