Dysmenorrhoea Flashcards
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What is dysmenorrhoea?
Painful menstruation (+/- nausea and vomiting)
What is the incidence of dysmenorrhoea?
50% women complain of moderate pain, 12% of severe disabling pain
What is dysmenorrhoea associated with?
High prostaglandin levels in the endometrium and is due to contraction and uterine ischaemia
What types of dysmenorrhoea are there?
Primary dysmenorrhoea
Secondary dysmenorrhoea
What is primary dysmenorrhoea?
Dysmenorrhoea is pain without organ pathology (no organic cause found)
Often starting with anovulatory cycles after menarche (common in adolescents)
How does primary dysmenorrhoea present?
Crampy, with ache in back/groin, worse during first day or two
How is primary dysmenorrhoea managed?
NSAIDs to inhibit prostaglandins e.g. mefenamic acid 500mg/8h PO during menstruation (reduce contractions, and subsequent pain)
Paracetamol good alternative
Ovulation suppression e.g. COCP can help
Smooth muscle anti-spasmodic e.g. hyoscine butylbromide 20mg/6h PO give unreliable results
Cervical dilatation at childbirth may relieve but surgical dilatation may render cervix incompetent so no longer used as therapy
What is likely if medical treatment for primary dysmenorrhoea fails?
Pelvic pathology
What is secondary dysmenorrhoea?
Pain due to pelvic pathology e.g. -Adenomyosis -Endometriosis -PID -Fibroids -Ovarian tumours As such, appears later in life
What symptoms are associated with secondary dysmenorrhoea?
Pain preceding (and often relieved by) menstruation i.e. more constant through period
Deep dyspareunia
Menorrhagia/irregular menstruation
What Ix can be performed in secondary dysmenorrhoea?
Pelvic USS
Laparoscopy
How is secondary dysmenorrhoea managed?
Treat underlying cause e.g. with hormonal contraception (be aware, IUCDs increase dysmenorrhoea with the exception of Mirena, which normally reduces it)
Laparoscopic uterine nerve ablation not effective
