1. DR FELICIA MOLOKOANE Dysmenorrhoea

2. Introduction Medical condition Characterized by severe uterine pain during menses Manifesting as cyclical lower abdominal pain 40 – 70% women suffer from this condition Leading cause of absenteeism

3. Introduction Exact cause is not fully understood Classified into  Primary: occurs in the absence of any underlying diseases  Secondary: usually due to underlying pathology

4. Pathogenesis Uterine hyperactivity Prostaglandins Vasopressin

5. Primary dysmenorrhoea Usually start within 6 – 12 months after menarche, when ovulatory cycles are established Symptoms begin a few hours before the start of menstruation Often relieved during the 1 st few days of bleeding

6. Primary dysmenorrhoea There may be associated symptoms  Headache, nausea, vomiting and diarrhoea On examination there are no abnormal findings

7. Secondary dysmenorrhoea Can occur at any time after menarche Usually present after the 3 rd and 4 th decade of life Causes  Endometriosis  Fibroids  Adenomyosis  Endometrial polyps  PID

8. Investigations No investigation is necessary for 1° dysmenorrhoea 2° dysmenorrhoea  Pelvic ultrasound  Swabs for chlamydia  Laparoscopy if suspicious of endometriosis

9. Treatment of 1° dysmenorrhoea NSAIDs  Inhibit the prostaglandin synthesis, and decrease uterine contractility  Can reduce pain up to 70% Other analgesia COCs

10. Treatment of 1° dysmenorrhoea Mirena Transcutaneous electrical nerve stimulation Locally applied heat

11. Acupuncture Laparoscopic uterine nerve ablation

12. Treatment of 2° dysmenorrhoea Treat the cause