Dysmenorrhea. Abdullah Baghaffar. Definition:. Dysmenorrhea is defined as Painful menstruation The term dysmenorrhea is derived from the Greek words: dys , meaning difficult/painful/abnormal meno , meaning month rrhea , meaning flow. Classification.
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1- Primary painful menstruation not associated with pelvic pathology
2- Secondary painful menstruation caused by pelvic pathology
-Back pain & pain in the upper thighs 60%
-Nausea /vomiting 89%
-Fatigue / malaise 85%
-Dizziness, nervousness, fainting in severe cases
1. NSAID1st line 80% effective
2. ORAL CONTRACEPTIVES 90% effective If NSAID are not effective or contraindicated
5. Nonpharmacologic pain management:
6. Surgical procedures
Mechanism of Action
2- Oral Contraceptives
Pain extends to premenstrual or post menstrual phase or may be continuous, may also have deep dysparueunia, premenstrual spotting and tender pelvic nodules (especially on the uterosacral ligaments); onset is usually in the 20s and 30s but may start in teens
Initially pain may be menstrual, but often with each cycle it extends into the premenstrual phase; may have intermenstrual bleeding, dyspareunia and pelvic tenderness.
Uterus is generally clinically and symmetrically enlarged and may be mildly tender; dysmenorrhea is associated with a dull pelvic dragging sensation.
A dull, ill-defined pelvic ache, usually worse premenstrually, aggravated by standing, relieved by menses; often a history of sexual problems.
A pelvic exam is indicated at the initial evaluation which should be performed to exclude uterine irregularities, cul du sac tenderness or nodularity that may suggest endometriosis, PID or pelvic mass. It should be completely normal in a Pt with 1ry dysmenorrhea, however if evaluated during the pain uterus & cx will be mildly tender.
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