Dysmenorrhea By

Dr. Ali Abd El Monsif Thabet

Definition

Pain related to menstruation that may occur just before or during menses.

Types

There are different types including

1- Primary (spasmodic) dysmenorrhea

2- Secondary (congestive) dysmenorrhea

3- Membranous dysmenorrhea

4- Ovarian dysmenorrhea

* Ovulatory pain

* Premenstrual tension syndrome

1- SPASMODIC DYSMENORRHEA

Definition

It is sever colicky pain in the lower abdomen that may radiated suprapubically or to the inner aspect of the thigh and may accompanied with backache and other symptoms such as nausea, vomiting, headache, diarrhea and fatigue.

Incidence

Etiology

A- Abnormal anatomy

B- Nervous disturbance

C- Hormonal imbalance

D- Abnormal physiology

• CLINICAL SYPTOMS

• SIGNS

MANAGEMENT • A- General and psychological

• B- Drug therapy

• C- Surgical treatment

• D- Physical therapy

2 -SECONDARY (CONGESTIVE) DYSMENORRHEA

• Definition

• It is continuous dull aching lower abdominal pain accompanied by backache occurring in multiparas women after many years of relatively painless menstruation due to pelvic congestion which is more marked in premenstrual period.

• Incidence

• It is common in multiparas women between 30-40 years, it starts few days (3-5 days) before menstruation, increased in severity as menstruation approaches and relieved by the onset of menstrual flow (diminution of pelvic congestion).

• Etiology

• It caused by pelvic congestion that caused by :-

• 1- simple congestion as constipation or coitus interrupts

• 2- chronic inflammation as cervicitis and salpingitis

• 3- displacement R.V.F. and prolapse

• 4- neoplasm as fibroid

• 5- endometriosis

• 6- I.U.C.D.

• Treatment

• 1- treatment of the cause

• 2- avoid constipation

• 3- active life

• 4- mild analgesic

• 5- cold showers

• 6- glycerin icthyol pessaries

• 3- MEMBRANOUS DYSMENORRHEA

• It is rare condition resembles spasmodic dysmenorrhea and in addition the endometrium is shed in form of big membranous casts due to an abnormality in its separation.

• 4- OVARIAN DYSMENORRHEA

• It is premenstrual dull aching pain occurring in one or both iliac fossae in patient with pelvic congestion leading to ovarian congestion.

• OVULATORY PAIN

• It is mid-cycle pain in one iliac fossa due to increased tension in mature follicle or rupture of the follicle at ovulation causing irritation of the peritoneum.

• PREMENSTRUAL TENSION SYNDROME

• It is premenstrual irritability, depression and pain in breasts and sensation of

fullness in the abdomen which occur few days before menstruation and relieved by menstruation. It is due to salt retention or

increase estrogen and deficient progesterone.

Thank you