Transcript 8-DYSMENORRHEA [Dr.Ahmed].ppt

DYSMENORRHEA
AHMED ABDULWAHAB
CONSULTANT
ASSISTANT PROFESSOR
 Classification.
 Primary dysmenorrhea .
 Occurs during ovulatory cycles, and
usually 6 to 12 month after menarche.
 Etiology.
 Uterine contractions with ischemia and
increase contractility, and resting tone due
to prostaglandin production.
 There is associated symptoms like nausea
vomiting and headache. Unovulatory cycle
contain little PGs and hence painless.
 Clinical features
 Cramping pain usually begin few hours
before the cycle and may persist for hours
or days .
 It is localized in the lower abdomen and
may radiate to the thigh and lower back
 May be associated with altered bowel
habits , nausea ,fatigue , dizziness, and
headache .
 treatment
 NSAIDs are highly effective , ibuprofen
and mefenamic acid may cause GIT
disturbance .
 Other class the cyclo-oxygenase inhibitor
that have little effect on GIT.
 Oral contraceptive pills by inhibiting
ovulation .
 Progestins .
 Tocolytic.
 Secondary dysmenorrhea.
 It is secondary to an underlying cause and
PGs may play a role .
 Clinical features .
 Generally the pain is not limited to the
menses and can occur before as well as
after the menses .
 It develops in older women and usually
associated with other symptoms like
dyspareunia , infertility and abnormal
uterine bleeding .
 Causes .
 1-Endometriosis .
 Pain in pre and postmenstrual phase
,there is deep dyspareunia and tender
pelvic examination .
 Pelvic inflammation , like endometriosis
initially pain may be menstrual and often
extend into the premenstrual phase with
each cycle, may have inter menstrual
bleeding .
 2-Fibroid and adenomyosis.
 There is dull dragging sensation , uterus is
clinically enlarged and may be tender.
 3-Ovarian cysts .
 Should be clinically evident.
 4-Pelvic congestion .
 There is dull ill-defined pelvic ache ,
usually worse pre-menstrually and relived
by menses .
 Treatment .
 Treatment of the underlying disease .
 The treatment used for the primary
dysmenorrhea are often helpful .