A Family Doctor;s Tale - DYMENORRHEA

DOC I HAVE MENSES PAIN

This is a very common complaint in a family doctor clinic or gynecologist's clinic. Every woman has at least one episode of menses pain in her lifetime.

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


Dysmenorrhea may be classified into:
1.Primary or Spasmodic Dysmenorrhea -
2.Secondary Dysmenorrhea due to causes like
Endometriosis ( A Simple Guide to Endometriosis) or 
Pelvic Inflammatory Disease ( A Simple Guide to Pelvic Inflammatory Disease)


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 require to force out the menstrual flow.


Primary Dysmenorrhea:


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:


1. Starts about 1 week before menses and reach maximum on first day before reducing intensity for rest of menses period
2.dull aching pain in lower abdomen with radiation to the back


Associated symptoms may be associated with dysmenorrhea:
1.vomiting,
2.urinary frequency,
3.headache,
4.painful breasts,
5.abdominal distension,
6.depression and
7.irritabilty.

Treatment for Dysmenorrhea:


Primary Dysmenorrhea:

1.simple analgesics like paracetamol
2.Non-steroidal anti-inflammatory drugs like Ponstan, Synflex
3.Antispasmodics
4.Tranquillizer or antidepressant
5.Muscle relaxant
6.female hormones


Secondary Dysmenorrhea:

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


Primary Dysmenorrhea may end with first pregnancy due to widening of uterine opening.
Secondary Dysmenorrhea prognosis depends on the treatment of causes.