PRIMARY DYSMENORRHEA Kanadi Sumapraja Division of Reproductive Immuno-endocrinology Department of Obstetrics and Gynecology Faculty of Medicine University of Indonesia

DEFINITION Painful menses in women with normal pelvic anatomy

ETIOLOGY Smooth muscle contraction PGF2a PGE2

ETIOLOGY

ETIOLOGY Phospholipid from the death cells Prostaglandin Prostacyclin Thromboxane Arachidonic acid PGG2 PGH2 Phospholipase A2 COX Isomerase

Attempts to lose weight Disruption of social networks RISK FACTORS Age < 20 years Attempts to lose weight Depression / anxiety Disruption of social networks Heavy menses Nulliparity Smoking

CLINICAL PRESENTATION Usually presents during adolescence, within three years of menarche Unusual for symptoms to start within the first six months after menarche Pain usually develops within hours of the start of menstruation and peaks as the flow becomes heaviest during the first day or two of the cycle Symptoms of nausea, vomiting, diarrhea, fatigue, fever, headache or lightheadedness

SECONDARY DYSMENORRHEA Dysmenorrhea occurring during the first one or trwo cycles after menarche Dysmenorrhea beginning after 25 years of age Late onset dysmenorrhea Pelvic abnormality Little or no response to therapy with NSAIDs, OC or both

TREATMENT A = consistent, good-quality, patient-oriented evidence; B = inconsistent or limited quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series.

ROS INDUCES PGF2a Endometrial stroma Decidualized endometrial stroma cell Sugino et al, 2001

NSAID can reduce PGF2a Sugino et al, 2001

SOD regulated by steroid Sugino et al, 2002

ROS and SOD During normal cellular respiration, oxygen is reduced to water and highly reactive superoxide ( )

ROS and SOD These reactive oxygen species (superoxide) react with nucleic acids, sugars, proteins and lipids - eventually leading to protein degradation.

ROS and SOD balance

Antioxidant

Antioxidant role of vitamin E Free Radical Quenched Free Radical Polyunsaturated Fatty Acid Protein Cholesterol Phospholipid

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