Primary dysmenorrhoea Flashcards
What is dysmenorrhoea?
Painful periods
Crampy abdominal pain which starts at the onset of menstruation
What are the two types of dysmenorrhoea
Primary
Secondary
Describe primary dysmenorrhoea
Menstrual pain with no underlying pelvic pathology
Describe secondary dysmenorrhoea
Menstrual pain that occurs with an associated pelvic pathology
Describe what happens physiologically during a period?
In absence of fertilisation of the egg, the corpus luteum regresses and there is a decline in oestrogen and progesterone production
Endometrial cells sensitive to decline in progesterone and respond with prostaglandin release
What are the two main actions of prostaglandins in the uterus?
Spiral artery vasospasm
Increased myometrial contractions
What is primary dysmenorrhoea thought to occur secondary to?
Excessive release of prostaglandins by endometrial cells
Which prostaglandins are released?
PGF2a and PGE2
What are the risk factors of primary dysmenorrhoea
Early menarche Long menstrual phase Heavy periods Smoking Nuliparity
Describe the clinical features of primary dysmennorhoea
Lower abdominal or pelvic pain which can radiate to lower back or anterior thigh
Crampy pain
Lasts 48-72 hours around the menstrual period and is characteristically worst at the onset of menses
Associated with other symptoms - malaise, nausea, vomiting, diarrhoea and dizziness
What is found on abdominal and pelvic examination in dysmenorrhoea?
Unremarkable
Maybe uterine tenderness
List the differentials for dysmenorrhoea
Endometriosis Adenomyosis Pelvic inflammatory disease Adhesions IBD IBS
What investigations can be done for dysmenorrhoea
None specific - so rule out other pathology
STI - high vaginal swab and endocervical swab
TV USS for pelvic mass
What is the main aim of treating primary dysmenorrhoea
Symptomatic improvement
Describe the lifestyle advice for treating primary dysmenorrhoea
Stop smoking
