1. DYSMENORRHEA Ozgul Muneyyirci-Delale

2. DYSMENORRHEA Primary Secondary

3. CAUSES OF SECONDARY DYSMENORRHEA Tissue or Organ SystemPathology PeritoneumEndometriosis Allen-Masters’ syndrome Pelvic congestion syndrome OvaryOvarian cysts or tumor Fallopian TubesPelvic inflammatory disease (acute and chronic) UterusAdenomyosis Uterine myomas Uterine polyps Intrauterine adhesions (Asherman’s syndrome

4. UterusCongenital malformations (bicornuate and septate uterus, blind uterine horn) IUD Cervix Stenosis VaginaImperforate hymen Transverse vaginal septum

10. COMPOUNDS THAT INHIBIT PROSTAGLANDIN FORMATION (In decreasing order of potency) Meclofenamic acid>niflumic acid= Indomethacin>mefenamic acid> Flufenamic acid>naproxen> Phenylbutazone>aspirin or ibuprofen

11. DYSMENORRHEA A favorable response to placebo was observed in 84% in the first cycle, 21% in the second, 16% in the third, and 10% in the fourth (Fedele L et al, 1989).

12. OTHER TREATMENT MODALITIES FOR DYSMENORRHEA Transcutaneous electrical nerve stimulation Terbutaline inhalation Levonorgestrel-releasing intrauterine device Vasopressin antagonist Vasopressin VI receptor antagonist Transdermal nitroglycerine Acupuncture Herbal medicine (shakuyaku-kanzo-to) Cyclooxygenase-2 inhibitor Leukotriene receptor antagonist

13. TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) TENS relieves primary dysmenorrhea through two mechanisms: 1. The pregangionic fibers are bombarded with impulses that saturate the nerve cells of the dorsal horn (the gate control theory). 2. TENS induces the release of endorphins from these nerve cells.