Dysmenorrhea Flashcards
In which ages does dysmenorrhea peak?
Ages 19-24 years
What is primary dysmenorrhea?
It is severe painful colicky, cramp like spasmosdic pain in the lower abdomen associated with menstruation in the absence of an organic pathology
-it can present with nausea, vomiting, dizziness, headaches and sometimes syncope
What is secondary dysmenorrhea?
It is severe pain presenting with menstruation with a secondary pathology
What is the pathophysiology of primary dysmenorrhea?
Prostaglandins are released(PGF2 alpha) which causes myometrial vasoconstriction and uterine ischaemia
Type c afferent pain neurons are stimulated which causes spasmodic pain
What causes the pain in primary dysmenorrhea?
- Uterine ischaemia
- Uterine contractions
- Prostaglandin
What are the risk factors for primary dysmenorrhea?
- Early age of menarche
- Smoking
- Nulliparity
- Long and heavy menstrual flow
- Strong family history (where mom and sisters had dysmenorrhea)
- High levels of stress or anxiety or depression
- Young between 19 and 24 years
What are the clinical features of primary dysmenorrhea?
- Cramping, spasmosdic pain in the lower abdomen radiating to the back and inner thighs
- Nausea, vomiting, headache, syncope, diarrhea
What is the grading system that we use for primary dysmenorrhea?
Grade 0- not painful, no disruption of normal activities and no analgesia needed
Grade 1- mild pain, mild affects day top day life, rarely needed
Grade 2- painful, needs analgesia and affects day activities
Grade 3- severe pain(vegetative, nausea, vomiting), and poor effect of analgesia
What special investigations do we do in these patients?
Abdominal ultrasound to exclude pathology and if worried about ectopic pregnancy do b-hCG
What are the 3 ways to manage dysmenorrhea?
- Pharmacological
- Non-pharmacological
- Surgical
What are the pharmacological choices for dysmenorrhea?
- NSAIDS(inhibit prostaglandin synthesis)
- ibuprofen 400-800mg 6hourly
- mefenamic acid 250-500mg 6 hourly - Combination oral contraceptives
- Mirena
What are the non-pharmacological management options?
- Heat therapy-heat patches, hot water bottle
- Acupuncture
- TENS-Transcutaneous electrical nerve stimulation
What surgical treatment can we do for patients with primary dysmenorrhea?
- LUNA-laparoscopic uterosacral nerve ablation
2. Pre-sacral neurectomy
What supplements can we give to the patients?
- Vitamin B12
- Thiamine
- Magnesium
- Vitamin E
- Omega 3 fatty acid
- Transdermal nitroglycerin
What is the clinical presentation of dysmenorrhea?
- Pain is constant or diffuse and precedes menses by several days and can last through the menstrualk period
2.
What special investigations do we do for secondary dysmenorrhea?
- Pelvic ultrasound
- Cervical and uterine abnormalities
- Hysteroscopy
- Laparoscopy under general anaesthesia is the gold standard
Treatment for endometriosis?
Laparoscopic excision using leader or electrosurgery
Or laparoscopic ablation
Treatment for PID?
Systemic antibiotics and NSAIDs are used
Surgery may be required in stage 3 or 4
What is the treatment for pelvic congestion syndrome?
This occurs due to engorgement of the pelvic vasculature
The pain is throbbing and worse at night and after standing
Diagnosis is made at laparoscopy which demonstrates congestion of the uterus and broad ligament and pelvic side wall veins
What is the management of ovarian cysts?
Ovarian cystectomy
What is the management for leimyomatas and polyps
- Open or laparoscopic myomectomy
- Hysteroscopic removal
- Transcervica endometrial resection
- Hysterectomy
