Dysmenorrhea

 

• Definition and causes

  Painful periods.

  

  
  

  Primary dysmenorrhea

  • No organ pathology.
  • Usually starts 6-12 months post-menarche i.e. once cycle is established.

  Secondary dysmenorrhea

  Occurs later in life, secondary to organ pathology:

  • Fibroids
  • Adenomyosis and endometriosis.
  • Adhesions
  • Uterine polyps
  • PID
  • IUCD

• Signs and symptoms

  Primary dysmenorrhea:

  • Symptoms worse on 1st or 2nd day of period.
  • Crampy pain.
  • Lower abdo pain radiating to back and groin.
  • Associated symptoms: nausea, vomiting, diarrhoea, fatigue, headache.

  Secondary dysmenorrhea:

  • Pain constant through period and possibly through luteal phase.
  • Irregular or heavy bleeding.
  • Dyspareunia
  • Bloating
  • Discharge

• Management

  NSAIDs:

  • Ibuprofen, naproxen, or mefenamic acid.
  • All are equally effective, though ibuprofen has fewest side effects.

  Hormonal:

  • Combined contraceptive pill.
  • Progestins: levonorgestrel IUS (Mirena), desogestrel (Cerazette), Depo-Provera.

  Treatment of underlying cause:

  • Surgical removal of fibroids or endometriosis.
  • Antibiotics for PID.