DR FELICIA MOLOKOANE

Dysmenorrhoea

Introduction

Medical condition

Characterized by severe uterine pain during menses

Manifesting as cyclical lower abdominal pain

40 – 70% women suffer from this condition

Leading cause of absenteeism

Introduction

Exact cause is not fully understood

Classified into Primary: occurs in the absence of any underlying

diseases

Secondary: usually due to underlying pathology

Pathogenesis

Uterine hyperactivity

Prostaglandins

Vasopressin

Primary dysmenorrhoea

Usually start within 6 – 12 months after menarche, when ovulatory cycles are established

Symptoms begin a few hours before the start of menstruation

Often relieved during the 1st few days of bleeding

Primary dysmenorrhoea

There may be associated symptoms Headache, nausea, vomiting and diarrhoea

On examination there are no abnormal findings

Secondary dysmenorrhoea

Can occur at any time after menarche

Usually present after the 3rd and 4th decade of life

Causes Endometriosis Fibroids Adenomyosis Endometrial polyps PID

Investigations

No investigation is necessary for 1° dysmenorrhoea

2° dysmenorrhoea Pelvic ultrasound Swabs for chlamydia Laparoscopy if suspicious of endometriosis

Treatment of 1° dysmenorrhoea

NSAIDs Inhibit the prostaglandin synthesis, and decrease

uterine contractility Can reduce pain up to 70%

Other analgesia

COCs

Treatment of 1° dysmenorrhoea

Mirena

Transcutaneous electrical nerve stimulation

Locally applied heat

Acupuncture

Laparoscopic uterine nerve ablation

Treatment of 2° dysmenorrhoea

Treat the cause