1. DYSMENORRHEA AHMED ABDULWAHAB CONSULTANT ASSISTANT PROFESSOR

2.  Classification.  Primary dysmenorrhea.  Occurs during ovulatory cycles, and usually 6 to 12 month after menarche.  Etiology.  Uterine contractions with ischemia and increase contractility, and resting tone due to prostaglandin production.  There is associated symptoms like nausea vomiting and headache. Unovulatory cycle contain little PGs and hence painless.

3.  Clinical features  Cramping pain usually begin few hours before the cycle and may persist for hours or days.  It is localized in the lower abdomen and may radiate to the thigh and lower back  May be associated with altered bowel habits, nausea,fatigue, dizziness, and headache.

4.  treatment  NSAIDs are highly effective, ibuprofen and mefenamic acid may cause GIT disturbance.  Other class the cyclo-oxygenase inhibitor that have little effect on GIT.  Oral contraceptive pills by inhibiting ovulation.  Progestins.  Tocolytic.

5.  Secondary dysmenorrhea.  It is secondary to an underlying cause and PGs may play a role.  Clinical features.  Generally the pain is not limited to the menses and can occur before as well as after the menses.  It develops in older women and usually associated with other symptoms like dyspareunia, infertility and abnormal uterine bleeding.

6.  Causes.  1-Endometriosis.  Pain in pre and postmenstrual phase,there is deep dyspareunia and tender pelvic examination.  Pelvic inflammation, like endometriosis initially pain may be menstrual and often extend into the premenstrual phase with each cycle, may have inter menstrual bleeding.

7.  2-Fibroid and adenomyosis.  There is dull dragging sensation, uterus is clinically enlarged and may be tender.  3-Ovarian cysts.  Should be clinically evident.  4-Pelvic congestion.  There is dull ill-defined pelvic ache, usually worse pre-menstrually and relived by menses.

8.  Treatment.  Treatment of the underlying disease.  The treatment used for the primary dysmenorrhea are often helpful.