A Simple Guide to Dysmenorrhea

A Simple Guide to Dysmenorrhea
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What is Dysmenorrhea?
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Dysmenorrhea is a symptom, not an illness.
It means painful menstruation.

What are the types of Dysmenorrhea?
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Dysmenorrhea may be classified into:

1.Primary or Spasmodic Dysmenorrhea

2.Secondary Dysmenorrhea due to causes like

Endometriosis or

Pelvic Inflammatory Disease

What are the Causes of Dysmenorrhea?
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The cause of primary Dysmenorrhea is still not known.

There are a few theories:
1.during menstruation, contraction of the uterine muscles occurs in spasms trying to push the menstrual flow through a narrow cervical opening

2.Prostagladins output occurs at time of menstruation producing muscles spasms

3.Menstrual clots occludes the uterine opening and requires more contractions of the uterine muscles to push it through

4.Stress may constrict the opening of the uterus and hence greater contraction of the uterine muscles is required to force out the menstrual flow.

What are the Symptoms of Dysmenorrhea?
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Primary Dysmenorrhea:
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1.typically occurs on the first day of menses and becomes less after the 2nd day.

2.lower abdominal cramp radiating down to thighs and back

Secondary Dysmenorrhea:
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1. Starts about 1 week before menses and reach maximum on first day before reducing intensity for rest of menses peroid

2.dull aching pain in lower abdomen with radiation to the back

Symptoms may be associated with
1.vomiting,

2.urinary frequency,

3.headache,

4.painful breasts,

5.abdominal distension,

6.depression and

7.irritabilty.

What is the Treatment for Dysmenorrhea?
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Primary Dysmenorrhea:
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1.simple analgesics like paracetamol

2.Non-steroidal anti-infammatory drugs like Ponstan, Synflex

3.Antispasmodics

4.Tranquilliser or antidepressant

5.Muscle relaxant

6.female hormones

Secondary Dysmenorrhea:
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1.Identify and treat the underlying cause(eg. antibiotics for PID)

2.Endometriosis may require a course of female hormones or surgery for control

3.Dilatation of the endocervical canal may help

What is the prognosis of Dysmenorrhea?
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Primary Dysmenorrhea may end with first pregnancy due to widening of uterine opening.

Secondary Dysmenorrhea prognosis depends on the treatment of causes.

A Simple Guide to Endometriosis

A Simple Guide to Endometriosis

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What is Endometriosis ?

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Endometriosis is a disorder of the endometrial tissues (which line a woman's uterus) in which these tissues are implanted in places outside the uterus, usually in other parts of the pelvic cavity and abdomen.

However, in women with Endometriosis, blood from the implanted endometrial tissue is trapped inside, becomes inflamed, and develops into scar tissue.

Because of this inflammation, severe pain, infertility and bowel problems occur.

What are the Causes of Endometriosis?

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The cause of endometriosis is still not known.

There are a few theories:

1.during menstruation, some of the menstrual tissue is pushed back through the fallopian tubes into the abdomen where it implants and grows.

2.it may be due to a genetic process

3.certain families are predisposed to endometriosis:

Higher socioeconomic groups

women who marry late and have no or few children

4.Stress may constrict the opening of the uterus .

Some endometrial tissues are pushed backward into the abdominal cavity instead of through the opening of the uterus

What are the Symptoms of Endometriosis?

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Endometriosis occurs usually years after the periods begin.

Symptoms may worsen as the endometrial area increases in size.

However after menopause, the implanted tissue shrinks away and the symptoms subside.

Common symptoms include:

Severe menstrual cramps

Pelvic pain apart from menstrual periods

Diarrhoea or painful bowel movements during menses

Menstrual irreuglarities

Menorrhagia

Painful intercourse

Backache

Pain with exercise

Painful pelvic exams

Painful and frequent urination

Bloating

Constipation

Fatigue

How do you made the Diagnosis of Endometriosis ?

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A diagnosis can only be made via laparoscopy.

A laparoscope is a tube with a light in it which is inserted through a small incision in the navel area. The misplaced endometrial tissue can then be found and the location, extent and size of the endometriosis detected.

What is the Treatment for Endometriosis?

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There is no cure for endometriosis.

If the symptoms are mild, only medication for pain is required.

Treatment depends on the size, extent of the lesions, age of the patient and the desire for pregnancy.

If these women want to be pregnant, the best course of action is to have a trial period of unprotected intercourse for 6 months to 1 year.

Once pregnancy occur, the endometriosis will cleared by itself because there is no menses for nine months. Whether the endometriosis will recur after delivery depends on the patient. Most patients do not have a recurrence.

If the patient is not seeking pregnancy and where specific treatment of the endometriosis is required, hormone suppression treatment may be tried. This prevents ovulation and less endometrial tissue is formed. Because of this the endometriosis may reduced resulting in less symptoms. A course of treatment may last 6 months.

Where hormone suppression therapy do not work, some patients may require surgical treatment to remove the endometriosis tissue in the abdomen.

In severe cases, where the uterus and ovaries are affected, removal by surgery of the uterus and/or ovaries is required especially in those nearing menopause or who do not wish to be pregnant.