Dysmenorrhea By Dr. Ali Abd El Monsif Thabet

Definition Pain related to menstruation that may occur just before or during menses. Types There are different types including 1- Primary (spasmodic) dysmenorrhea 2- Secondary (congestive) dysmenorrhea 3- Membranous dysmenorrhea 4- Ovarian dysmenorrhea * Ovulatory pain * Premenstrual tension syndrome

1- SPASMODIC DYSMENORRHEA Definition It is sever colicky pain in the lower abdomen that may radiated suprapubically or to the inner aspect of the thigh and may accompanied with backache and other symptoms such as nausea, vomiting, headache, diarrhea and fatigue.

Incidence

Etiology A- Abnormal anatomy B- Nervous disturbance C- Hormonal imbalance D- Abnormal physiology

CLINICAL SYPTOMS SIGNS

MANAGEMENT A- General and psychological B- Drug therapy C- Surgical treatment D- Physical therapy

2- SECONDARY (CONGESTIVE) DYSMENORRHEA Definition It is continuous dull aching lower abdominal pain accompanied by backache occurring in multiparas women after many years of relatively painless menstruation due to pelvic congestion which is more marked in premenstrual period.

Incidence It is common in multiparas women between years, it starts few days (3- 5 days) before menstruation, increased in severity as menstruation approaches and relieved by the onset of menstrual flow (diminution of pelvic congestion).

Etiology It caused by pelvic congestion that caused by :- 1- simple congestion as constipation or coitus interrupts 2- chronic inflammation as cervicitis and salpingitis 3- displacement R.V.F. and prolapse 4- neoplasm as fibroid 5- endometriosis 6- I.U.C.D.

Treatment 1- treatment of the cause 2- avoid constipation 3- active life 4- mild analgesic 5- cold showers 6- glycerin icthyol pessaries

3- MEMBRANOUS DYSMENORRHEA It is rare condition resembles spasmodic dysmenorrhea and in addition the endometrium is shed in form of big membranous casts due to an abnormality in its separation.

4- OVARIAN DYSMENORRHEA It is premenstrual dull aching pain occurring in one or both iliac fossae in patient with pelvic congestion leading to ovarian congestion.

OVULATORY PAIN It is mid-cycle pain in one iliac fossa due to increased tension in mature follicle or rupture of the follicle at ovulation causing irritation of the peritoneum.

PREMENSTRUAL TENSION SYNDROME It is premenstrual irritability, depression and pain in breasts and sensation of fullness in the abdomen which occur few days before menstruation and relieved by menstruation. It is due to salt retention or increase estrogen and deficient progesterone.

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