Dysmenorrhea

Defination=dysmenorrhea means painful cramping pain accompanying menstruation.

Aetiology
TYPES
1)primary dysmenorrhea=refers to one that is not associated with any identifiable pelvic pathology.It affects more than 50%of post pubescent women in age group of 18 to 25 yr.
2)secondary dysmenorrhea refers to one that is associated with presence of organic pelvic pathology. i.e. Fibroids,adenomyosis,PID,endometriosis

VARIETIES

1)spasmodic dysmenorrhea is most prevalent and manifest as cramping pain
2)Congesuite dysmenorrhea manifest as increasing pelvic discomfort and pelvic pain few days before menses begins.
3)Membranous dysmenorrhea in this endometrium is shed as cast at time of menstruation. It is accompanied by painful uterine cramps.

Clinical features=
1)present in 70%of teenagers and 30 to 50%of menstruating women.
2)its prevalance is higher amongst intelligent and sensitive working class women.
3)symptoms are result of increased level of prostaglandins in menstrual fluid.
4)this result in uterine cramping nausea vomiting back ache diarrhoea giddiness syncope and fainting.
5)primary dysmenorrhea is most intense on first day of menses and progressively lessen with menstrual flow.

INVESTIGATIONS

1)PELVIC sonography followed by CT scan or MRI.
2)diagnostic hysterosalpingogram/sonosalpingogrphy.
3)endoscopy

TREATMENT
IT INCLUDES counselling psychotherapy to alter her behavioral attitude.

Medical measures =measures to relieve pain and suppressing ovulation.
1)analgesics like paracetamol 500 mg tds or piroxicam 20 mg/bd
2)antispasmodic like hyoscine
3)prostaglandin synthetase inhibitors NSAIDs like mefenamic acid 250-500 mg/qd.
Indomethacin 25 mg 3 to 6 times daily.
4)glyceryl trinitrate by relaxing smooth muscle relieve pain
5)progestogen containg IUCD
6)OC pills supress ovulation nd are useful in releiving dysmennorrhoea.

SURGERY
indicated when medical measures fail to provide relief.
1)diagnostic hysteroscopy followed by dilatation nd curettage,excision of polyp.
2)diagnostic laparascopy follwed by lysis of pelvic adhesions.Myomectomy.Draing of chocolate cyst
3)laparotomy followed by eradication of endometriosis myomectomy.
4)hysterectomy in elderly women
5)trans cutandous nerve stimulation