Dysmenorrhoea

Question 1

Define

Answer 1

Painful periods

Question 2

Primary dysmenorrhoea:

Define?

Symptoms:
- What days of the period does it tend to be worse?
Pain:
- Site
- Radiation - 2
- Other associated symptoms - 5

Answer 2

Pain without organ dysfunction

1st and 2nd day

Lower abdo pain
Radiates to back and groin

N&V
Diarrhoea
Fatigue
Headache

Question 3

Secondary dysmenorrhoea:

Define?

Causes?

Symptoms:
- What time in reproductive life does it tend to occur?
Pain:
- Is the pain constant or intermittent?
- What about the bleeding?
- What else may they have pain doing?
- Other symptoms - 2

Answer 3

Pain with organ dysfunction

Adenomyosis
Endometriosis
PID
Fibroids

Later in life

Irregular or heavy bleeding
Dyspareunia

Bloating
Discharge

Question 4

Management:

Type of analgesia used to manage pain?

What other type of treatment can be done to reduce symptoms?

Answer 4

NSAIDs

Ibuprofen 
Naproxen 
Mefenamic acid 
-------
Hormonal

Question 5

Types of hormonal treatments:

What can be used to stop periods, therefore, no pain?

Why can progesterone be given?
Gives some examples of this?

What hormone does mefenamic acid inhibit making it particularly good for painful periods?

Answer 5

Combined contraceptive pill - stops your periods

Progesterone relaxes the uterine smooth muscle. However, stress can indirectly deplete progesterone levels. Many women suffer from too much estrogen & not enough progesterone, therefore getting too many uterine contractions & not enough uterine relaxation- this can lead to period pain.

Progestins:

• Levonorgestrel IUS (Mirena)
• Desogestrel (Cerazette)
• Depo-Provera

Prostaglandins:

Shortly before a period begins, the endometrial cells that form the lining of the uterus make large amounts of prostaglandins. When these cells break down during menstruation, the prostaglandins are released. They constrict the blood vessels in the uterus and make its muscle layer contract, causing painful cramps.

Question 6

What particular Rx can be done for 2* dysmenorrhoea?

Answer 6

Treating the underlying cause - surgery for fibroids and endo

Antibiotics for PID